Keywords
Septicaemia
Electrolyte abnormalities
Categories
How to Cite
Abstract
Introduction: Despite the continuing struggle, Bangladesh's under-five mortality rate is still high. However, Bangladesh has significantly reduced childhood mortality from 173 per thousand. The high level of neonatal deaths in Bangladesh is a great concern among all health professionals. Objective: This study aims to determine the frequency and pattern of electrolyte imbalance in neonates with septicemia and their impact on mortality and morbidity. Methods: All neonates suffering from septicemia and admitted to Bangabandhu Sheikh Mujib Medical University (BSMMU) from 1 January 2011 to 15 September 2011 who fulfilled the inclusion criteria were evaluated. Results: During the study period, a total of 120 neonates were admitted with the diagnosis of septicemia in the Department of Neonatology, BSMMU, Dhaka, Bangladesh. Among the neonates, the mean age was 9.26 ± 4.58 days, mean weight 2282.68 ± 580.40 gm, and mean gestational age 35.68 ± 2.40 weeks; 66 were males (55%), and 54 were females (45%). Electrolyte abnormalities were found in 42 (35%) neonates with septicemia. Among the electrolyte abnormalities, hyponatremia was found in 24 (20%) neonates, hypernatremia in 12 (10%), hypokalemia in 17 (14.2%), hyperkalemia in 19 (15.8%), and mixed abnormalities in 18 (15%) cases. Neonates with dyselectrolytemia were found to be significantly associated with prolonged hospital stay compared to those with normal electrolyte levels (p < 0.05). Hyponatremia, hypokalemia, and mixed electrolyte abnormalities were significantly associated with higher mortality (p < 0.05). However, hypernatremia and hyperkalemia were not significantly associated with higher mortality (p > 0.05). Conclusion: Electrolyte abnormalities are common in neonates with septicemia. They contribute considerably to the higher mortality and prolonged hospital stay of neonates irrespective of the primary disease.
References
Students’ Hand Book, IMCI-Integrated Management of Childhood illness. Revised print in Bangladesh. January 2008. Acknowledgement. [Accessed 2022 Mar 01]. Available from: https://apps.who.int/iris/bitstream/handle/10665/42939/9241546441.pdf?sequence=1&isAllowed=y
Bangladesh Demographic and Health Survey 2007. Preliminary Report; 2009: 25-26. [Accessed 2022 Mar 01]. Available from: https://dhsprogram.com/pubs/pdf/FR207/FR207[April-10-2009].pdf
Duke T. Neonatal pneumonia in developing countries. Arch Dis Child Fetal Neonatal Ed. 2005; 90(3): F 211-F219. https://doi.org/10.1136/adc.2003.048108
Hossain MM, Mannan MA, Shahidullah M. Pattern of admissions and morbidity with outcome of neonates admitted in tertiary level hospital in Bangladesh. SOUVENIR, 6th National Conference; Bangladesh Neonatal Forum: 2010.
Annual Report 2008. Department of pediatrics, Dhaka Medical College Hospital; 9.
Hossain MM, Shirin M, Mamun AA. Electrolyte Abnormalities in Neonates Admitted in Intensive Care Unit. Bangladesh J Child Health. 2004; 28: 13-17.
Rao SDS, Thomas B. Electrolyte Abnormalities in Children Admitted to Pediatric Intensive Care Unit. Indian Pediaric. 2000; 37(12): 1348-53.
Chawla D, Agarwal R, Deorari AK. Fluid and Electrolyte Management in Term and Preterm Neonates. Indian J Pediatr. 2008; 75(3): 255-9. https://doi.org/10.1007/s12098-008-0055-0
Modi N. Hyponatremia in the newborn. Arch Dis Child Fetal Neonatal Ed.1998; 78(2): F81-4. https://doi.org/10.1136/fn.78.2.f81
Rees L, Brook CGD, Shaw JCL. Hyponatremia in the first week of life in preterm infants. Part-I Arginine Vasopressin secretion. Arch Dis Child. 1984; 59(5): 414-22. https://doi.org/10.1136/adc.59.5.414
Easterbrook PJ. Renal Physiology. In: Easterbrook PJ, editor. Basic Medical Sciences for MRCP Part 1. 3rd ed. London: Elsevier Churchill Livingstone: 2005;198-200.
Barrett KE, Boitano S, Barman SM, Brooks HL. Regulation of Extracellular Fluid composition and volume. Ganong’s Review of Medical Physiology. 23rd ed. New York: The McGraw-Hill companies: 2010; 665-678.
Gomella TL, Cunningham MD, Eyal FG. Body Water, Fluid and Electrolytes. Neonatology: Management, Procedures, On-call Problems, Diseases and Drugs. 6th ed. USA: The McGraw-Hill Companies: 2009; 68-75.
Greenbaum LA. Electrolyte and Acid-Base Disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th edition. Philadelphia: Saunders, Elsevier: 2007; 267-309.
Singhi S, Prasad SVSS, Chung KS. Hyponatremia in sick children, a marker of seruous illness. Indian pediatr. 1994; 31:19-24. [Accessed 2022 Mar 01]. Available from: https://www.indianpediatrics.net/jan1994/19.pdf
Bhat SR, Lewis P, Dinakar C. Hypernatremic Dehydration in a neonate. Indian Pediatr. 2001; 38: 1174-7. [Accessed 2022 Mar 01]. Available from: https://www.indianpediatrics.net/oct2001/oct-1174-1177.htm
Singhi S, Gulati S, Prasad SV. Frequency and Significance of Potassium Disturbances in Sick Children. Indian Pediatr 1994; 31(4): 460-3.
Ambalavanan N. Fluid, electrolyte and nutrition management of the newborn. Medscape. 2018. [Accessed 2022 Mar 01]. Available from: https://emedicine.medscape.com/article/976386-overview
Tollner U. Early diagnosis of septicaemia in the newborn: Clinical studies and sepsis score. Eur J Pediatr. 1982; 138(4): 331-7. https://doi.org/10.1007/bf00442511
Afroza S, Begum F. Co-relation between sepsis score and blood culture report in neonatal septicaemia. J Banglad Colleg Phys Surg. 2008; 26:79-82. https://doi.org/10.3329/jbcps.v26i2.4185
Peter D. Infection in the newborn. In: Rennie JM, Reberton’s NRC, eds. Textbook of Neonatology. 4th ed. London: Elsevier Churchill Livingstone: 2005; 1017-18.
Srivastava RN, Bagga A. Electrolyte and Acid Base Disorders. In: Srivastava RN, Bagga A, eds. Pediatric Nephrology. 4th ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd: 2005; 81-105.
Berry PL, Belsha CW. Hyponatremia. Pediatr Clin N Am. 1990; 37(2):351-63. https://doi.org/10.1016/s0031-3955(16)36873-0
Schoen EJ, Bhatia S, Ray GT, Clapp W, To TT. Transient pseudohypoaldosteronism with hyponatremia hyperkalemia in infant urinary tract infection. J Urol. 2002; 167(2 pt 1):680-82. https://doi.org/10.1097/00005392-200202000-00063
Conley SB. Hypernatremia. Pediatr Clin N Am. 1990; 37(2):365-71. https://doi.org/10.1016/s0031-3955(16)36874-2
Brem AS. Disorders of potassium homeostasis. Pediatr Clin North Am. 1990; 37(2):419-27. https://doi.org/10.1016/s0031-3955(16)36877-8
Marudkar A, Singhi S. Hypokalemia in pediatric intensive care unit. Indian pediatr. 1996; 33(1):9-14.
Mandal AK, Saklayan MG, Hillman NM, Market RJ. Predictive factors for high mortality in hypernatraemic patients. Am J Emergency Med. 1997; 15(2):130-2. https://doi.org/10.1016/s0735-6757(97)90082-6
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Copyright (c) 2021 Aminul Islam, Mohammad Alauddin, Mohammad Azam Khan; Abdullahel Amman; Md. Gias Uddin
