Cüneyt TAYMAN, Alparslan TONBUL, SALİH AYDEMİR, Aydın KÖŞÜŞ, Mustafa Mansur TATLI

Anne sütüne bağlı hipernatremik dehidratasyonun klinik bulguları ve tedavi önerileri

Amaç: Sadece anne sütü ile beslenen term bebeklerde hipernatremik dehidratasyon (DH) sıklığını, eslik eden sikâyetleri, risk faktörlerini değerlendirmek, dehidratasyon derecesini evrelemek, hipernatremik DH tedavisi için öneride bulunmak amaçlanmıstır. Gereç ve Yöntem: Yenidoğan Polikliniğimize basvuran term, sadece Anne sütüyle beslenen, %7’den fazla kilo kaybı olan ve serum sodyum değeri ≥147 mEq/L olanlar çalısmaya alındı. Anneye, bebeğe ait tıbbi öykü, eslik eden sikâyetler, risk faktörleri, gayta-idrar sıklığı, fi zik muayene, laboratuar bulguları, kilo kaybı, tedavi süresi, saatlik sodyum düsüs hızı hesaplanarak kayıt edildi. Yüzde kilo kayıplarına göre DH dereceleri hafi f, orta, ağır olarak belirlendi. Bulgular: 3642 hastadan 126’sında (%3.5) DH saptandı. Hastalar Grup 1, hafi f DH (n=59, %47), grup 2, orta DH (n=43, %34), grup 3, ağır DH (n=24, %19) olarak belirlendi. Eslik eden klinik bulgular sarılık (%46.8), ates (%42), zayıf beslenme (%36.5), dıskı ve idrar miktarında azalma (%32.5) idi. Dehidratasyona ait bulgular gurup 3’te diğer gruplara göre daha fazlaydı. Gurup 3’te basvurudaki postnatal yas, hastanede kalma süresi, kan üre, kreatinin değerleri, sodyum değeri diğer gruplara göre belirgin yüksekti. Grup 3’te intravenöz sıvı desteği diğerlerine göre daha fazla yapıldı. Gruplar arasında sodyum düsme hızı aynıydı. Ağır DH grubunda 2 hastada könvülziyon görüldü. Yüzde kilo kayıplarıyla serum sodyum, üre, kreatinin değeri arasında pozitif korelasyon vardı. Sonuç: Erken dönemde DH’u gösteren bulgularının belirgin olmaması hipernatremik DH tanısını geciktirmektedir. Dehidratasyon derecesini belirleyecek spesifi k bulgu mevcut değildir. En belirgin bulgusu olan kilo kaybına sarılık, ates, idrardıskı çıkısında azalma eslik etmektedir. Tedaviyle ilgili ortak bir protokolün olusturulması kafalardaki soruların çözümü olacaktır.

Clinical fi ndings and treatment recommendations of hypernatremic dehydration due to breast milk

Objectives: In this study, we aimed to assess the incidence, presenting complaints, risk factors of hypernatremic dehydration (DH), and to stage the degree of hypernatremic DH among term, exclusively breast feeding infants, and to suggest a therapy for hypernatremic DH. Methods: Term, exclusively breast feeding neonates admitted to our neonatology policlinics, with a more than 7% weight loss, serum sodium concentrations of ≥147 mEq/L were allocated for the study. ‘Maternals and infants’ medical history, examination, including presenting complaints, risk factors, stool- urine frequency, weight loss, the duration of the treatment, the rate of sodium decrease by hourly was calculated and recorded. Percentage of weight loss by taking into account, degree of DH (mild, moderate, severe) was created. Results: Dehydration were determined in 126 of 3642 patients (3.5%). Patients were allocated as Group 1, mild DH (n=59, 47%), group 2, moderate DH (n=43, 34%), group 3, severe DH (n=24, 19%). Relevant clinical fi ndings on admission were jaundice (46.8%), fever (42%), poor oral feeding (36.5%), reduction in the amount of stool- urination (32.5%). Clinical fi ndings of dehydration were more frequent than other groups in group 3. On the admission day, postnatal age, blood urea, creatinine levels, duration of the therapy, sodium levels were higher than other groups in group 3. Intravenous (IV) fl uid requirement was over than other groups in group 3. Only two patients had seizures in the severe DH group. Positive correlation was determined between percentage of weight loss and serum sodium, urea and creatinine levels Conclusion: Diagnosis of hypernatremic DH is delayed, because of no obvious signs of dehydration is present in the early period. There is no specifi c sign to determine the degree of DH. Weight loss is the most prominent fi nding, accompanied by jaundice, fever, a decrease in urine and stool frequencies. Creation of a common treatment protocol is the solution of questions in minds.

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