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Learn about Dehydration fever

Dehydration fever

Breast milk is the main nutrient for the growth and development of the infant. Normal neonatal feeding is advocated on demand every 2 hours. Intake of adequate breast feeding depends on normal mammary development (mammogenesis), unimpeded initiation of lactation (lactogenesis), sustained on-going milk synthesis (galactopoiesis), infant breastfeeding techniques. Total daily milk intake depends on the frequency and duration of feeds.

 

The World Health Organization recommends, all infants should be exclusively breastfed for the first 6 months of life,

Average weight loss is approximately 7-10% of birth weight in well babies during the first 3 days is normal. Also called physiological weight loss.  But if the weight loss is more than 10%, most of the times it is associated with breast feeding failure in Neonates.

 Dramatic weight loss and dehydration with an increase in serum sodium (Na) concentration related to the insufficient breast milk intake may be observed mostly on the initial days of the infant

Definition:-

Dehydration fever is a condition seen in first few days of neonates due to loss of body fluids and inadequate replacement through oral feeding. This leads to ineffective thermoregulation in a neonate’s body resulting in low grade fever to pyrexia.

 

Causes:-

- Physiological loss of fluid:-
Usually in first few days of life, the neonate loses weight. Infants' and neonates ‘have  higher body water content, along with their higher metabolic rates and increased body surface area to mass index, contribute to their higher turnover of fluids and solute. Therefore, they require proportionally greater volumes of water to maintain their fluid equilibrium and are more susceptible to volume depletion. Significant fluid losses may occur rapidly, leading to depletion of the intravascular volume.

- Inadequate Feeding:-
Inadequate fluid replacement with fluid depletion is the main cause of dehydration and that leads to fever.

- Excessive fluid loss due to external factors: -
External factors that leads to fluid loss due to convections/ wrapping in thick blanket , that causes excessive sweating to the child leads to dehydration.

- Excessive exposure to Heat:- over exposure to sun and fire causes the extra cellular fluids to evaporate quickly leading to again volume depletion.


Pathophysiology:-
Different factors leads ultimately to volume depletion. Causing dehydration and loss of body fluid, Loss of body fluid triggers thermoregulatory changes in body, causing fever, increased thirst sensation, low urine output. Dehydration itself probably affects the temperature regulatory centres in the brain. As dehydration and salt loss progress, however, the plasma volume and heart output decrease, with a consequent decrease in blood supply to the skin. Sweating decreases and may stop completely, and the main avenue for heat loss is closed. The body temperature may then rise precipitously.

Symptoms:-
- Temperature rises up to 100-101⁰  F.  
- Low urine output
- Weight loss greater than 10% of body weight                       
- Rise in temperature are seen on 3^rd to 4^th day of life
- Tachycardia
- Irritability
- Dry oral mucosa
- Fatigue
- Tachypnea
- Lethargy
- Sunken eyes                                                        
- Depressed fontanel
- Altered level of consciousness
- Disorientation
- Rehydration leads to lysis of fever
- Decreased skin turgor                      
 

Diagnosis:

History Taking:-

- It is important to differentiate other conditions that cause fever like infections
- Birth history, date and time and weight at birth is important in determining dehydration fever.
- Check maternal health history

Physical examination:-

- Measurement of temperature, pulse and respiration gives most of the answers
- Weight comparisons to that of during birth helps to determine the weight loss, though 8-10% of weight loss in initial days is common, more than 10% indicates an alarm
- Check for sunken eyes, depressed fontanel
- Check for skin turgor , elasticity.
- Check if the clothing of baby is appropriate or not.

Management:-

- Rehydration and proper feeding completely resolves the conditions.
- Maintaining a thermally safe environment is also important

Nursing management

Assessment:

- Assess the temperature, pulse and respiration of the baby
- Assess the birth history
- Assess the Maternal health history
- Assess the mammary gland of mother for infections,  inadequate lactogenesis
- Assess the clothing of the child
- Assess the surrounding environment for possible hazards that cause fluid loss
- Assess the breastfeeding technique of mother

Nursing Diagnosis:-

- Hyperthermia related to volume depletionas evidenced by temperature 99 F
- Ineffective breastfeeding related to poor knowledge of mother regarding breastfeeding technique as evidenced by improper holding of baby
- Deficient fluid volume related to physiological fluid loss and relatively inadequate intake as evidenced by dry lips
- Impaired urinary elimination related to fluid volume depletion as evidenced by low urine output
- Imbalanced energy field related to excessive irritability and restlessness as evidenced by lethargy
- Risk for electrolyte imbalance related to low extracellular fluid volume
- Risk for ineffective peripheral tissue perfusion related to depletion of intravascular volume
- Risk for dry mouth related to dehydration
 

Nursing Intervention

For hyperthermia:-
- Rehydration with breast milk is the best way to subside the hyperthermic state 
- Along with that , extra clothing , that causes sweating should be removed
- The child should not be kept near fire or in sun for a longer period of time
- If the room is heated by a heater, keep boiled water to humidify the room
- Sponge bath with luke warm water helps to maintain the temperature within normal range
- Put on light clothes on newborn
- Monitor temperature every 4 hourly and more frequently if required
 

To maintain effective Breastfeeding:-

- Provide adequate knowledge to parents, especially to mother about the technique of breastfeeding a baby.
- Encourage them to position the baby in an comfortable manner and teach them the signs of effective breastfeeding.
- Provide knowledge regarding the condition and encourage frequent breastfeeding
- Explain the mother about exclusive breastfeeding the neonates and its benefits

For volume maintenance:-

- Monitor Intake and output of the child strictly
- Watch for concentrated urine and other sign that indicates dehydration
- Find out the source of dehydration and treat accordingly
- Monitor body weight and nutritional status of the child
- Watch for depressed fontanel and sunken eyes or change in skin texture that indicates worsening in the condition.

To eliminate the risk of electrolyte imbalance:-​​​​​​​
- One main complication could be hyponatrimia, routine blood examination for sodium level and potassium level is important.

References:-

• TuiTui R. (2007), Manual of Midwifery III, 4^th edition, Kathmandu, Vidyarthi Pustak Bhandar
• Sherpa m.(,2074), essential textbook of Midwifery Nursing part-III, 1^st edition, Kathmandu, samiksha publication pvt.ltd
• Hassan M., Ardash E. (jan 10,2019),clinical profile of dehydration fever in neonates ,  http://dx.doi.org/10.18203/2349-3291.ijcp20190716
• R E APPLETON and C K Foo Child Health Unit,Princess Mary Maternity Hospital, Dehydration fever in the neonate-a common phenomenon? A case report.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1792028/pdf/archdisch00674-0129b.pdf

• MD, Koyfman,nov 12, 2018, Pediatric Dehydration, https://emedicine.medscape.com/article/801012-clinical
• The Editors of Encyclopaedia Britannica,December 7 , 2017,Dehydration, https://www.britannica.com/science/dehydration-physiology