View Contents. Hiponatremia, h.. BIBLIOGRAFÍA. Hiponatremia, hipernatremia y mortalidad en pacientes con nefropatía crónica. Mary E. Choi; Joseph Loscalzo. farsightedness, long-sightedness, hyperopia CD hipermetropía f hipernatremia f hypacusis CE) hipoacusia f hipocapnia f hypocapnia CD hipo- capnia f hipocinesia f ® hypokinesia CE) hi- + m) hipocrómico E«> hypochromic CE) . Hiponatremia e hipernatremia. Jose Miguel Castellón. Hiponatremia hipernatremia. fernandomolinalino. Fisiopatologia trastornos del Sodio.
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Severe neonatal hypernatremic dehydratation in the initiation of the breastfeeding: Rev Pediatr Aten Primaria.
Meaning of “hiponatremia” in the Portuguese dictionary
There are few studies on its incidence in Spain. We excluded patients with underlying conditions or concomitant infection.
We collected data on epidemiological, clinical, laboratory, treatment and outcome variables through the review of health records, followed by their statistical analysis. Twenty met the inclusion criteria. The most frequent reasons for seeking care were weight loss, jaundice and irritability.
The median age at admission was 5. The mean length of stay was 6. None of the patients died or had severe complications. We found an association with exclusive breastfeeding, primiparity and greater maternal age. In light of these results, it seems advisable to provide information on the warning signs at the time of discharge from the maternity ward, and to schedule the first checkup for the baby at an earlier time. Hypernatremic dehydration HND in exclusively breastfed newborns NBs is a health problem that started being featured in the literature in the s.
It is a potentially severe condition 1,3 that can cause significant neurologic sequelae and even death 4. Although the actual incidence of HND in Spain is unknown, it is considered a significant public health problem due to its repercussions; the estimated incidence is 1. Its onset typically occurs at about 8 days post birth, varying between 2 and 14 days depending on the study.
This condition is underdiagnosed, as it presents with nonspecific symptoms such as lethargy, although some patients become irritable instead. Furthermore, the baby may show signs of dehydration such as dry mucous membranes, a sunken fontanel, poor skin turgora malnourished appearance, jaundice, fever, oliguria or anuria or neurologic abnormalities.
The risk factors for HND described in the literature include inadequate feeding of NBs poor breastfeeding [BF] technique, poor sucking or low milk supplypreterm birth, small for gestational age or low birth weight, maternal primiparity, caesarean delivery, or failure of mothers to identify signs of inadequate feeding early on 4, Some authors have found an association between HND and high sodium concentrations in the breast milk of mothers that have difficulty BF, with absence of the physiological reduction in the concentration of this electrolyte 2, The aim of our study was to determine the incidence of hospital admission due to severe HND and to describe the associated risk factors for the purpose of proposing preventive measures.
We excluded patients born preterm, with concomitant infectious disease, with underlying disease or who died of unknown causes during the study. We retrieved the data from the health records of NBs admitted to our hospital.
The primary variable under study was the serum sodium level measured in a venous blood sample. Other variables we took into account were maternal age, parity, type of delivery, sex, gestational age at birth, chronological age at admission, weight at birth, at admission and at discharge, temperature at admission, type of feeding, presence of clinical signs of dehydration, creatinine, blood urea nitrogen BUN and urea levels at admission, serum glucose level at admission, referral to our hospital, previous assessment by another health professional, length of stay in days, admission to the paediatric intensive care unit PICUneed for additional diagnostic tests, presence of complications, comorbidity and mortality.
We also categorised the reason parents sought care in our hospital based on the presenting symptoms: We were able to conduct the study thanks to the standardisation of our electronic health records.
We compared our results for hipenatremia most important epidemiologic variables with the findings of previous studies.
HIPONATREMIA – Definition and synonyms of hiponatremia in the Portuguese dictionary
We performed the statistical analysis defining significance as a p -value of less than 0. We have summarised qualitative variables as frequencies with confidence intervals, and quantitative variables as medians with the corresponding interquartile range.
We used the recorded population for our catchment area as the susceptible population for the purpose of calculating the incidence of HND. We compared differences in the incidence between the warm seasons spring and summer and the cold seasons autumn and winter by means of the Student t test.
We preserved confidentiality by anonymising the data retrieved from health records. We estimated the size of the susceptible population during the period under study at 41 newborns, which corresponded to the newborns delivered in the maternity departments of one secondary level hospital and one tertiary level hospital that are both part of the public health system in the catchment area of our sample. Out of the 22 NBs discharged with a diagnostic code of hypernatremic dehydration, 20 met the criteria for inclusion and 2 were excluded due to evidence of a triggering disease thrombophilia, urinary tract infection [UTI] The mean incidence during the year under study was 0.
Table 1 summarises the jipo and clinical characteristic of the newborns and their mothers. The mean gestational age at birth was Two of the newborns hiprrnatremia delivered by caesarean section, one due to nonreassuring foetal heart rate tracings and the other due to prolonged labour. In the remaining cases, the family visited the emergency department in our hospital of their own initiative. The presenting complaints are summarised in Table 1: Other, less frequent reasons to seek care were refusal to feed and appearance of urate crystals in the diaper.
hipernatremia – Translation into English – examples Portuguese | Reverso Context
The median percentage of weight loss relative to the birth weight was The median serum sodium level was The medium serum creatine level in our sample hipernatrremia 0. Table 2 summarises the findings of other diagnostic tests. There were no deaths among the patients in our sample. The overall frequency of HND in our sample 0.
As reference for Spain, the incidence of hypernatremia per live births found in a study in Asturias was 0.
In contrast with the improvement in care delivery in other aspects, we did not find a declining trend in incidence in our patients during the period under study, nor in relation to the data from previous studies, which indicates that we need to develop strategies to address this yet unresolved problem. In our sample, all cases had onset within 15 days from birth, with a median age at admission that was slightly greater compared to the age reported in other case series, which can probably be explained by our study focusing on newborns admitted after discharge from the maternity ward.
The most common reasons care was sought in our case series were, with equal frequency, irritability and jaundice, presenting symptoms that were consistent with the literature, which also describes presentations with hypertonia and hyperreflexia, altered level of consciousness or seizures, which were not observed in any of our patients 14, As occurred in previously published case series, excessive weight loss from birth was a frequent feature, as was the appearance of urate crystals in the urine 14, In agreement with the previous literature, we did not find relevant features in the prenatal or perinatal history in our sample of NBs Contrary to other studies, we did not find an association with caesarean delivery, as in Spain this intervention usually does not entail a delay of more than 12 hours in BF initiation Most mothers in our sample were primiparous, and the median maternal age was 34 years, which was consistent with previous studies where the median ages of the mothers age were 30 17 and 34 years, The metabolic comorbidities found in our study were similar to those described in other studies in Spain, with mild acidosis detected in half of our sample, although our patients did not develop the disorders described in other case series while they received treatment to correct the acidosis 21, In our well-child programme, the first check-up visit is scheduled at 15 days post birth, which in our opinion is too late to detect problems derived from inadequate BF in at-risk NBs, as our data imply.
The scheduling of a first appointment at the end of the first week of life could help prevent HND associated with BF or at least reduce its incidence, and also support BF, preventing early discontinuation of BF due to inefficient technique or maternal discouragement Another possibility would be to schedule a visit to measure the NB on the day that they are brought in for the heel prick test, or to establish education programmes for mothers in maternity wards 13, Education of health care staff though the development of consensus documents and the implementation of BF support workshops for mothers are measures that succeeded in reducing the incidence of HND in other facilities in Spain 13, One of the limitations of our study, which was due to its retrospective design, was that we were unable to obtain data on parental educational attainment.
A future prospective study, one which would include an analysis of the impact of the improvement measures proposed here, could be the starting point to decrease the incidence of this health problem. Our study is the first in Spain to calculate the incidence of HND in newborns after discharge, identifying primiparity as a relevant maternal risk factor.
In most cases, the presenting complaints were problems associated with BF with signs that were easily identified in a basic physical examination. We believe that BF provides the best nutrition for the infant, but that it requires adequate monitoring, as having the hipernatrrmia routine child wellness checkup early on, at day 7 post birth, could help reduce the incidence of lactation failure and HND.
The authors have no conflicts of interest to declare in relation to the preparation and publication of this article. Reference of this article.: RESULTS We estimated the size of the susceptible population during the period under study at 41 newborns, which corresponded to the newborns delivered in the maternity departments of one secondary level hospital and one tertiary level hospital that are both part of the public health system in the catchment area of our sample.