Practical Management of Neonatal Hypernatremic Dehydration: A Clinical Study Publisher



K Mirnia KAYVAN ; Mm Saeedi Maryam MAHDAVI ; F Ghadamghahi FATEMEH ; D Fahimi DARYOOSH ; G Barikani GOLNAZ ; R Sattarpour REZA ; M Mirnia MELIKA ; R Sangsari RAZIEH
Source: Nephro-Urology Monthly Published:2025

Abstract

Background: Neonatal hypernatremic dehydration can lead to severe complications. The primary treatment for this condition is rehydration. However, varied treatment strategies depend on the specific hospital context. Objectives: This study investigated the practical management of hypernatremia in neonates with hypernatremic dehydration to simplify the treatment of these patients. Methods: We conducted a prospective observational cohort study enrolling neonates (≤ 28 days, gestational age ≥ 37 weeks) presenting with dehydration and serum sodium > 150 mEq/L at the neonatal intensive care unit (NICU) of Children's Medical Center from 2022 to 2024. A standardized intervention protocol was implemented, including a resuscitation phase with intravenous normal saline boluses and individualized maintenance fluid therapy. Neonates were stratified into three subgroups based on initial serum sodium concentrations (150-165, 166-175, and ≥ 176 mEq/L). The primary outcome was the rate of plasma sodium reduction, while secondary and tertiary outcomes included normalization timeframes, adverse events, and mortality. Results: In forty-three included neonates, analysis of variance (ANOVA) showed no statistically significant difference in the rate of sodium decline. Time to achieve serum sodium < 150 mEq/L varied: Group 1 (≤ 4 8 hours), group 2 (≤ 72 hours), and group 3 (≤ 6 days). Rehydration therapy was generally effective; the only complication was a seizure in one of the group 3 patients, who was discharged, and after 4 months of follow-up, he had normal development. Conclusions: Careful monitoring and individualized treatment are crucial for managing sodium levels and preventing adverse events in this vulnerable population. Further studies are warranted to refine rehydration strategies and improve outcomes in neonates with hypernatremia. © 2025 Elsevier B.V., All rights reserved.