急诊高渗性脱水的婴儿临床表现和结局。
Clinical Profile and Outcome of Young Infants With Hypernatremic Dehydration Presenting to the Emergency Department.
机构信息
From the Department of Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Department of Biochemistry, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
出版信息
Pediatr Emerg Care. 2024 Apr 1;40(4):e10-e15. doi: 10.1097/PEC.0000000000003028. Epub 2023 Aug 15.
OBJECTIVES
The aim of this study was to evaluate the clinical profile and outcome of young infants presenting to the pediatric emergency department with hypernatremic dehydration.
METHODS
A prospective observational study was conducted at a tertiary care teaching hospital over a period of 18 months. All outborn sick young infants aged 2 months or younger who presented to the emergency department with symptoms and signs of possible sepsis and/or dehydration were screened, and those with hypernatremia were enrolled in the study. Those infants born at less than 37 weeks of gestation and gross congenital anomaly were excluded. Hypernatremic dehydration was defined as serum sodium levels (Se Na+)higher than 145 mEq/L. Variables used in the study were defined as per standard definitions. Acute kidney injury was defined and staged using serum creatinine as per modified neonatal Kidney Disease Improving Global Outcome guidelines. Clinical presentation, laboratory parameters, and comorbidities were compared among outcome groups (survived and died).
RESULTS
Of 1124 outborn young infants who met the eligibility criteria for screening, 63 were diagnosed to have hypernatremic dehydration and 55 were enrolled. The hospital-based period prevalence of hypernatremic dehydration in young infants was 4.89%. The median age of presentation was 17 days (10-30). Male-to-female ratio was 1.1:1. Seventy-three percent were first in birth order. Feeding pattern showed 61.8%, 30.9%, and 7.3% of infants were exclusively breastfed, top fed, and mixed fed, respectively. The median serum sodium at the time of admission was 160 (153.5-167) mg/dL. Three (5.5%) infants had mild, 39 (70.9%) had moderate, and 13 (23.6%) had severe hypernatremic dehydration. There was statistically significant correlation between median platelet count with severity of hypernatremic dehydration. The mean time taken to correct serum sodium level was 3.30 ± 1.60 days. The case fatality rate was 41.8%. Those who died had statistically more severe hypernatremic dehydration, acute kidney injury, sepsis, and need for ventilation.
CONCLUSIONS
Acute kidney injury stage 3, shock, and need for ventilation are associated with poor outcome in infants with hypernatremic dehydration.
目的
本研究旨在评估儿科急诊就诊的高钠血症性脱水的婴幼儿患者的临床特征和结局。
方法
本前瞻性观察研究在一家三级教学医院进行，为期 18 个月。所有在出生后 2 个月或更小时因疑似败血症和/或脱水而出现症状和体征的外来病弱婴幼儿均接受筛查，其中高钠血症者被纳入研究。排除胎龄<37 周和严重先天性异常的婴儿。高钠血症性脱水定义为血清钠水平（SeNa+）>145 mEq/L。研究中使用的变量按标准定义定义。根据改良新生儿肾脏病改善全球结局指南，使用血清肌酐定义和分期急性肾损伤。比较结局（存活和死亡）组之间的临床表现、实验室参数和合并症。
结果
在符合筛选条件的 1124 名外来婴幼儿中，有 63 例被诊断为高钠血症性脱水，其中 55 例入组。婴幼儿高钠血症的医院内现患率为 4.89%。发病中位年龄为 17 天（10-30 天）。男婴与女婴的比例为 1.1:1。73%为首胎。喂养方式分别为纯母乳喂养、人工喂养和混合喂养，比例分别为 61.8%、30.9%和 7.3%。入院时血清钠中位数为 160（153.5-167）mg/dL。3 例（5.5%）为轻度，39 例（70.9%）为中度，13 例（23.6%）为重度高钠血症性脱水。血小板计数中位数与高钠血症性脱水的严重程度呈显著相关。血清钠纠正所需的平均时间为 3.30±1.60 天。病死率为 41.8%。死亡组的高钠血症性脱水、急性肾损伤、败血症和需要通气的发生率更高。
结论
急性肾损伤 3 期、休克和需要通气与高钠血症性脱水婴儿的不良结局相关。
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