Abstract :
Introduction: Normally neonates lose 5-7% of their birth weight in the first week of life. Inadequate breastfeeding resulting from different factors may result in dehydration and excessive weight loss. Hypernatremic dehydration leading to acute kidney injury (AKI) is a well-known complication of lactational insufficiency in exclusively breast-fed babies progresses from pre-renal to intrinsic renal injury, if persistent. Acute kidney injury (AKI) is a complex disorder which has a clinical manifestations ranging from mild dysfunction to complete anuric kidney failure.
Aim: To evaluate renal function tests (RFT) in term neonates with more than 10% weight loss within 7 days of life.
bjective: To determine the frequency of acute kidney injury in term neonates with more than 10% weight loss within 7 days of life.
1:To determine type of acute kidney injury (Prerenal, Renal); 2: Assess the percentage of dehydration in terms of percentage of weight loss (more than 10%, more than 15%); 3: Assess type of dehydration (hypernatremic, isonatremic, hyponatremic); 4: To assess type of dehydration with acute kidney injury.
Material and Methods: A hospital based prospective study was conducted on term neonates in a tertiary care hospital for period of 12 months from July 2019 to June 2020. Daily weight of all the neonates was recorded using electronic weighing machine. 103 new-borns presenting with weight loss of more than 10 % of birth weight within 7 days of life were enrolled as per convenient sampling technique without any bias. Neonates with congenital anomalies of kidney, sepsis, birth asphyxia and diabetes insipidus were excluded. Neonates were assessed by performing renal function test as a marker of dehydration.
Observation and Results: One hundred and three neonates with weight loss of more than 10% were enrolled in the study. Among them, 88 (85.4%) had prerenal AKI and 15 (14.5%) had renal AKI; 68(66%) neonates had dehydration of 10-15% while, 35 (34%) had dehydration of more than 15%. Most of the neonates 75(73.4%) had hypernatremic dehydration while 25(25%) and 3(1.5%) had isonatremic and hyponatremic dehydration respectively. 69, 16 and 3 neonates with prerenal AKI had Hypernatremia, isonatremia and hyponatremia respectively while 5 and 9 neonates with renal AKI had Hypernatremia and isonatremia respectively. None of the neonate had renal AKI with hyponatremia.
Conclusion : Hypernatremia is severe enough to cause prerenal AKI progressing to renal AKI in exclusively breast-fed babies without any associated comorbidities. Training of mothers, care givers and doctors and weight monitoring of breast-fed babies to identify at risk neonates is important in early diagnosis.
Keyword :
Acute kidney injury, Hypernatremic, nRIFLE criteria