What is the treatment for dehydration in neonates?

Treatment of Dehydration in Neonates

The first-line treatment for dehydration in neonates is oral rehydration therapy (ORT) using reduced osmolarity oral rehydration solution (ORS) containing 65-70 mEq/L sodium and 75-90 mmol/L glucose, with severe cases requiring intravenous fluids until vital signs normalize. 1

Assessment of Dehydration Severity

Dehydration in neonates should be categorized based on clinical signs:

• Mild dehydration (3-5%):

  • Increased thirst
  • Slightly dry mucous membranes
  • Normal vital signs

• Moderate dehydration (6-9%):

  • Loss of skin turgor
  • Dry mucous membranes
  • Sunken eyes
  • Decreased urine output

• Severe dehydration (≥10%):

  • Severe lethargy
  • Altered consciousness
  • Significantly decreased skin turgor
  • Tachycardia
  • Hypotension

Treatment Algorithm

1. Mild to Moderate Dehydration (3-9%)

• First-line therapy: Oral rehydration solution (ORS)

  • Use reduced osmolarity ORS containing 65-70 mEq/L sodium and 75-90 mmol/L glucose 1
  • Research shows 96.7% of neonates with average 5.1% dehydration can be successfully rehydrated orally 2
  • Administer ORS at a rate of 100 ml/kg over 4-6 hours

• Feeding during rehydration:

  • Breastfed infants should continue nursing on demand throughout the rehydration process 1
  • Formula-fed infants should resume full-strength, lactose-free or lactose-reduced formulas immediately after rehydration 1

2. Severe Dehydration (≥10%) or Shock

• Immediate IV fluid resuscitation:
  • Administer lactated Ringer's or normal saline until pulse, perfusion, and mental status normalize 1
  • Initial bolus: 20 ml/kg over 20-30 minutes, repeat if necessary
  • After stabilization, transition to ORS when the neonate can tolerate oral intake

3. Hypernatremic Dehydration (Serum Na >145 mEq/L)

• For serum Na 145-160 mEq/L:

  • Supervised quantified oral feeds at 150 ml/kg/day unless shock is present 3
  • Slower correction is crucial to prevent neurological complications

• For serum Na ≥160 mEq/L:

  • Initial IV fluid therapy with careful monitoring 3
  • Use 0.18% saline in 4.3% dextrose with early addition of potassium 4
  • Target sodium correction rate: no faster than 0.5 mEq/L/hour

Monitoring During Treatment

• Frequent vital sign checks (every 1-2 hours initially)
• Weight measurements before and after rehydration
• Intake and output monitoring
• Serum electrolytes, especially in severe or hypernatremic dehydration
• Clinical signs of hydration status
• Urine output (goal >1 ml/kg/hour)

Warning Signs Requiring Immediate Attention

• Persistent vomiting
• Bloody diarrhea
• Altered mental status
• High fever
• Failure to improve with oral rehydration
• Signs of acute kidney injury

Important Considerations

• Emesis is not a contraindication to oral rehydration therapy. Research shows that complete oral rehydration can be achieved despite vomiting 2

• Avoid prolonged use of diluted formulas or restrictive diets as they can result in inadequate nutrition 1

• Both glucose-based and rice syrup solids-based ORS are effective for rehydration in infants with mild to moderate dehydration 5

• Hypernatremia, hyponatremia, and acidosis present on admission can be corrected within hours with appropriate rehydration 2

• Monitor for acute kidney injury, which is common in dehydrated neonates but typically resolves with proper rehydration 3

Prevention of Dehydration

• Ensure proper breastfeeding technique and adequate milk supply, particularly for primiparous mothers 3
• Educate parents on recognizing early signs of dehydration
• Maintain appropriate hand hygiene and infection control measures 1
• Regular weight checks for at-risk neonates