Congenital Diarrhoea In A Neonate With Hypernatraemia And Dehydration.

Diarrhoea, vomiting, and dehydration are frequently encountered in neonatal emergency. However, it is challenging to manage resistant hypernatraemia and metabolic acidosis associated with it. Diagnosing the exact cause is even more difficult. Glucose-galactose malabsorption commonly presents with hypernatraemia and repeated dehydration. In the case described here, the baby started to have diarrhoea in the first week of life and presented in the neonatal emergency with severe dehydration and hypernatraemia. Higher sodium levels were difficult to manage throughout the course of illness. Hypernatraemia and diarrhoea worsened on feeding, whether formula or mother's feed, which raised suspicion of glucose and galactose malabsorption. So, genetic testing was performed and fructose based formula was started which led to improvement in the condition. Later, genetic testing confirmed our diagnosis. This case report emphasises that clinicians should consider the possibility that congenital diarrhoea could be due to glucose- galactose malabsorption while managing a case with loose stool and significant electrolyte imbalance in a neonate.

Blood Lactate Levels And Lactate Clearance As Predictors Of Mortality In Neonatal Sepsis.

BACKGROUND: Sepsis is life-threatening organ dysfunction caused by dysregulated host response to infection. Aim of the study is Neonatal sepsis refers to infection involving the blood stream in neonates. It is major health problem causing neonatal mortality and morbidity in developing countries. Our study aimed to assess the correlation between lactate clearance and blood lactate levels with outcome of neonatal sepsis. METHODS: Seventy-three eligible neonates recruited with convenience sampling technique. Study was conducted at the Neonatology department, The Children's Hospital & the Institute of Child Health, Lahore. After approval from institutional review board, and informed consent of parents/guardians, neonates with sepsis were selected through a present inclusion and exclusion criteria. Data was collected with the predetermined demographics, inflammatory markers and lactate levels. RESULTS: This research revealed 37% (n=27) mortality rate among septic neonates who were having higher blood lactate levels and low lactate clearance at 6 hours of admission in nursery. Hence higher serum lactate levels and low lactate clearance (<10%) at 6 hours were significant predictors of poor outcome in septic neonates (p-Value, <0.05). The lactate level of neonates who could not survive was 5.68±1.22 as compared to who were discharged 4.11±1.14 (p-Value, <0.05). CONCLUSIONS: Higher blood lactate levels and lactate clearance of less than 10% at 6 hours of admission in nursery are significant predictors of mortality in neonatal sepsis. Early lactate stabilization and sepsis management can improve the clinical outcomes.