Hypernatraemic dehydration and acute gastro-enteritis in children

A prospective study was conducted over a 2-year period to detect the effect of feeding practice, in particular the role of artificial milk formulae, in children admitted with hypernatraemic dehydration (serum sodium > or = 150 mmol/L) caused by acute gastro-enteritis, and to record morbidity and mortality in these patients. A control group was selected from infants and children admitted with gastro-enteritis but normal sodium levels. Sixty-seven children aged 18 days to 18 months (mean 6.9 months) were studied and represented 4.6% of all children admitted during the study with acute gastro-enteritis. Their mean serum sodium level was 161 mmol/L, the highest being 194 mmol/L. Twenty-four infants (36%) with hypernatraemic dehydration were on evaporated cow's milk powder compared with ten (15%) in the control group (p < 0.01). Five hypernatraemic infants (7.5%) were breastfed compared with 40 (60%) isonatraemic controls (p < 0.00001). Six children from the hypernatraemic group developed convulsions and two died. Hypernatraemic dehydration remains an important and serious complication in infants with gastro-enteritis in our area. Artificial milk feeding, particularly the use of evaporated cow's milk powder, is a predisposing factor for hypernatraemia in infantile gastro-enteritis. This study emphasises the importance of breast-feeding and the need to educate mothers to avoid giving evaporated cow's milk formulae to babies under 1 year of age if breast-feeding is not possible.