Krzemień GraŻyna, Pańczyk-Tomaszewska MAłGORZATA, Antonowicz-Zawiślak Agnieszka, Szmigielska Agnieszka
Department of Pediatrics and Nephrology, Medical University of Warsaw, Poland.
Pol Merkur Lekarski. 2020 Oct 23;48(287):307-311.
The aim of the study was to assess clinical profile of neonates with hypernatremic dehydration (HD) and identify risk factors associated with acute kidney injury (AKI).
A retrospective study included 18 neonates with HD (serum Na ≥150 mmol/L) hospitalized in the Department of Pediatrics and Nephrology between the years 2009-2019.
The age at presentation was 7.5±4.7 days (range 2-18), weight loss was 15.9±8.3% (range 7.1-32.6) and serum Na range was 151- 192 mmol/L (median 155.5 mmol/L). In 12 (67%) neonates, breast or mixed fed, HD occurred due to inadequate milk intake, in 6 (33%) neonates feeding difficulties were secondary to an acute infection. There was positive correlation between serum Na level and percentage weight loss at presentation (r=0.88; p<0.001). In 6 (33%) patients serious complications of HD were found: AKI in 5 patients, convulsions in one. Percentage weight loss was significantly higher in neonates with HD-associated AKI than in neonates with HD without AKI (p<0.01). Serum Na level was marginally higher in neonates with AKI than in those without AKI (p=0.08). In univariate logistic regression analysis, higher percentage of weight loss and higher serum Na level at presentation were important diagnostic factors of AKI in neonates with HD (both p<0.05). ROC analysis determined good diagnostic profile only for percentage weight loss, with a best cut-off value of 24.8%, for predicting AKI in neonates with HD (AUC 0.862, sensitivity 80%, specificity 100%).
Neonatal HD mostly occurs due to inadequate milk intake in breast or mixed fed babies, and rarely due to feeding difficulties in babies affected by an acute infection. Percentage weight loss at presentation has strong association with neonatal HD and is the most important factor of AKI in neonates with HD.
本研究旨在评估高钠血症脱水（HD）新生儿的临床特征，并确定与急性肾损伤（AKI）相关的危险因素。
一项回顾性研究纳入了2009年至2019年间在儿科和肾脏病科住院的18例HD新生儿（血清钠≥150 mmol/L）。
就诊时年龄为7.5±4.7天（范围2 - 18天），体重减轻15.9±8.3%（范围7.1 - 32.6%），血清钠范围为151 - 192 mmol/L（中位数155.5 mmol/L）。12例（67%）新生儿为母乳喂养或混合喂养，HD是由于奶量摄入不足所致；6例（33%）新生儿喂养困难继发于急性感染。就诊时血清钠水平与体重减轻百分比呈正相关（r = 0.88；p < 0.001）。6例（33%）患者出现HD严重并发症：5例发生AKI，1例惊厥。HD相关AKI新生儿的体重减轻百分比显著高于无AKI的HD新生儿（p < 0.01）。AKI新生儿的血清钠水平略高于无AKI者（p = 0.08）。单因素逻辑回归分析显示，就诊时较高的体重减轻百分比和较高的血清钠水平是HD新生儿发生AKI的重要诊断因素（均为p < 0.05）。ROC分析仅确定体重减轻百分比具有良好的诊断特征，预测HD新生儿发生AKI的最佳截断值为24.8%（AUC 0.862，敏感性80%，特异性100%）。
新生儿HD大多发生于母乳喂养或混合喂养婴儿奶量摄入不足时，很少因急性感染患儿喂养困难所致。就诊时体重减轻百分比与新生儿HD密切相关，是HD新生儿发生AKI的最重要因素。
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