Feeds Alone versus Intravenous Fluids and Feeds for Treatment of Mild Hypernatremia in Otherwise Healthy Neonates – An Open-labeled Randomized Controlled Noninferiority Trial

Background: The treatment of hypernatremia in newborns is usually done by giving intravenous (IV) fluids. Methodology: This study aimed to determine whether treating neonates with hypernatremia using oral feeds was not inferior by a margin of 10% to treatment with IV fluids and feeds in achieving a safe decline in serum sodium. A decrease in serum sodium ≤0.5 mEq/L/h over 24 h of treatment was considered a safe decline. Neonates with serum sodium 150-155 mEq/L were randomized to receive oral feeds ad libitum (Group A) or 5% dextrose +0.45% normal saline (D[sub.5] ½ NS) and oral feeds (group B). Results: There were 43 neonates in Group A and 42 neonates in Group B. It was found that a safe decline in serum sodium was seen in 60.5% of Group A neonates and 47.6% of Group B neonates (P = 0.246). There was no significant difference in the duration of treatment or duration of hospital stay. Group B babies had more weight gain compared to Group A. No complications were observed in the groups. Conclusion: Treating mildly hypernatremic neonates with serum sodium 150-155 mEq/L using oral feeds alone may not be inferior to IV fluids with oral feeds in achieving a safe decline in serum sodium. Keywords: Hypernatremia in neonates, intravenous fluids, oral feeds, safe decline in serum sodium