RESUMEN
Despite the countless benefits of breast milk, each year many infants are admitted to NICU's with clinical symptoms and laboratory indicators of dehydration and renal failure due to the lack of a national program to monitor post discharge breastfeeding over the first few days of life. In addition to identifying the role of inadequate breast milk intake as a cause of renal failure, the purpose of this study was to assess causes, clinical presentations and laboratory tests in acute renal failure and to identify the most available and practical laboratory test to differentiate prerenal from renal azotemia. A cross-sectional prospective study was performed between April 2005 and May 2006 [14 months] at Afzalipour Medical Centre in Kerman, Iran. All neonates with high serum blood urea and creatinine were included in the study. The percentage of weight loss, breast feeding, mode of delivery, and clinical presentations were recorded. Laboratory tests such as blood urea, serum and urine sodium and creatinine and, urine specific gravity were done. Data were analyzed by SPSS software, chi- square test and t- test. Among 36 neonates, who were eligible for the study, 29 cases [80%] had dehydration [group I] and 7 cases [20%] had intrinsic renal failure [group II]. In the first group, mean weight loss was 14% and mean age at admission was 10 days. Reasons for admission were poor feeding [69%], lethargy [58%], fever [30%], jaundice, vomiting and seizure. The mode of delivery in 69% of cases were vaginal route and 82% of cases were breast-fed. Decreased urine frequency in the previous day [<6 times per day] was considered more significant than decreased stool frequency [< 3 times per day]. Serum sodium and urine specific gravity in group I was significantly higher than group II [P<0.05]. This study confirms that an excessive weight loss over the first few days of life and decreased urine and stool frequency might be considered as a warning for failure of receiving enough milk. Serum sodium and urine specific gravity are the most sensitive laboratory parameters, for the assessment of dehydration