Staub Eveline, Wilkins Barry
Helen McMillan Paediatric Intensive Care Unit, The Children's Hospital at Westmead, New South Wales, Australia.
J Paediatr Child Health. 2012 Sep;48(9):859-62. doi: 10.1111/j.1440-1754.2012.02529.x.
Problems with lactation can result in hypernatraemic dehydration in the neonate, with potentially severe adverse consequences. This is illustrated in this fatal case of a 10 day old neonate who presented with excessive hypernatraemic dehydration due to insufficient breast milk intake, resulting in cerebral sinus vein thrombosis with cerebral haemorrhage and infarction. Differential diagnosis included excessive sodium intake (through inappropriately mixed formula or house remedies or through hyperaldosteronism) and high water deficit (renal or gastrointestinal losses, nephrogenic or central diabetes insipidus), all of which were ruled out by specific investigations or history. No evidence was found for inborn error of metabolism. The dehydration in this baby, however, was accentuated by trans-epidermal water loss due to an ichthyosiform skin condition. This first ever reported Australian fatality from neonatal hypernatraemic dehydration supports the concern of health care professionals over rising incidences of this entity in exclusively breastfed infants, and should encourage endorsement of improved monitoring of weight loss in newborns and breastfeeding support for their mothers.
哺乳问题可导致新生儿高钠血症性脱水，可能产生严重的不良后果。一名10日龄新生儿的致命病例说明了这一点，该患儿因母乳摄入不足出现严重的高钠血症性脱水，导致脑静脉窦血栓形成并伴有脑出血和梗死。鉴别诊断包括钠摄入过多（通过不当调配的配方奶或家庭疗法或原发性醛固酮增多症）和高水缺乏（肾脏或胃肠道丢失、肾性或中枢性尿崩症），所有这些均通过特定检查或病史排除。未发现代谢先天性缺陷的证据。然而，由于鱼鳞病样皮肤状况导致的经皮水分流失加剧了该婴儿的脱水。这是澳大利亚首次报告的新生儿高钠血症性脱水死亡病例，支持了医护人员对纯母乳喂养婴儿中该病症发病率上升的担忧，并应促使认可加强对新生儿体重减轻的监测以及为其母亲提供母乳喂养支持。
