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Neonatal hypernatraemic dehydration — RACP Paediatrics MCQ

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HardNeonatologyNeonatal hypernatraemic dehydrationRACP Paediatrics

A 5-day-old breastfed infant presents with lethargy and poor feeding. Birthweight was 3.4 kg and current weight is 2.95 kg; sodium is 160 mmol/L and glucose is normal. The baby is mildly dehydrated but not shocked. What is the most appropriate management?

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Correct answer: D — Admit for careful rehydration with breastfeeding and lactation support

This baby has hypernatraemic dehydration from inadequate intake and needs admission, careful fluid correction, monitoring of sodium and skilled feeding support. Rapid hypotonic correction can precipitate cerebral oedema and is a tempting but unsafe shortcut. A practical pearl is that weight loss beyond expected physiological loss, lethargy and hypernatraemia should be managed in hospital even if shock is absent.

Reference: RCH Clinical Practice Guidelines: Neonatal hypoglycaemia and dehydration; Therapeutic Guidelines (eTG)