• Sayeeda Huq Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
  • Shafiqul Alam Sarker Institute of Nutrition and Food Sciences (INFS), University of Dhaka, Bangladesh
  • Khursheed Jahan Institute of Nutrition and Food Sciences (INFS), University of Dhaka, Bangladesh
  • Nazma Shaheen Institute of Nutrition and Food Sciences (INFS), University of Dhaka, Bangladesh




Hypernatremia, children, developmental assessment


Purpose: Imbalances in sodium result in acute neurologic symptoms such as seizures and impaired mental status. Studies investigating the long-term consequences of hypernatremia on cognitive, motor, and language development in children are limited. The aim of this study was to assess the long-term impact of hypernatremia on children’s cognitive, motor, and language development. Methodology:It was an observational study conducted from March 2016 to March 2017 in Dhaka Hospital of icddr,b. In this study,211 children with acute watery diarrhea accompanied with hypernatremia (serum sodium level ³150 mmol/L)  who had already been enrolled in a previous observational study were prospectively followed for one  year.The objective was to investigate if there are any long term  neurologic and developmental consequences of hypernatremia in those children.

Physical, cognitive, motor, and language development as well as expressive or receptive expression of the children were assessed using a standard tool at the time of discharge (Baseline) and 12 months after discharge (End line). We also assessed IQ in a subgroup of children > 36 months (n=57) using the Wechsler Preschool and Primary Scale of Intelligence in parallel. Results: Among the 211 participants, developmental assessment on motor, cognitive, and language development test was done on 140 (66.3%) children. The mean age of the children at the time of discharge from the hospital (baseline) was 7.9±4.5 months. Compared to mild (serum Na 150 mmol/L to less than 160 mmol/L), and moderately (serum Na 160 mmol/L to 169 mmol/L) hypernatremia, children with severe hypernatremia (serum sodium >170mmol/L) significantly had lower mean scores on the motor, fine motor, and language development score at baseline after adjusting age and weight for the age z score. Although there was an improvement in motor, language, and socioemotional scores, significant improvement was only observed with cognitive function at the end line (p=0.002). In Mmultiple regression after adjusting for potential confounders such as levels of hypernatremia, parents’ education, age of the child, and WAZ, these factors were showed significantly associated with the cognitive function of children. There was no difference in mean IQ level performed at the end-line among the children with different level of hypernatremia (mild, moderate or severe). Conclusion: Children with hypernatremia had poor developmental scores in cognitive, motor, language, and socio-emotional domains at the time of recovery from hypernatremia. However, other than cognitive score, there was no significant improvement in motor or language development at 12 months in children recovering from hypernatremia.  Further studies are therefore warranted to reveal any association of motor or language deficit with neurological deficit in those children beyond 12 months.


ABOUD, F. E., SINGLA, D. R., NAHIL, M. I. & BORISOVA, I. 2013. Effectiveness of a parenting program in Bangladesh to address early childhood health, growth and development. Social Science & Medicine, 97, 250-258.

ALBERS, C. A. & GRIEVE, A. J. 2007. Review of Bayley scales of infant and toddler development.

ANDERSON, P. J., DE LUCA, C. R., HUTCHINSON, E., ROBERTS, G., DOYLE, L. W. & GROUP, V. I. C. 2010. Underestimation of developmental delay by the new Bayley-III Scale. Archives of pediatrics & adolescent medicine, 164, 352-356.

BAYLEY, N. 2006. Bayley scales of infant and toddler development.

BERKMAN, D. S., LESCANO, A. G., GILMAN, R. H., LOPEZ, S. L. & BLACK, M. M. 2002. Effects of stunting, diarrhoeal disease, and parasitic infection during infancy on cognition in late childhood: a follow-up study. The Lancet, 359, 564-571.

BLACK, M. M., WALKER, S. P., FERNALD, L. C., ANDERSEN, C. T., DIGIROLAMO, A. M., LU, C., MCCOY, D. C., FINK, G., SHAWAR, Y. R. & SHIFFMAN, J. 2017. Early childhood development coming of age: science through the life course. The Lancet, 389, 77-90.

BOSKABADI, H., AKHONDIAN, J., AFARIDEH, M., MAAMOURI, G., BAGHERI, S., PARIZADEH, S. M., MOBARHAN, M. G., MOHAMMADI, S. & FRENS, G. A. 2017. Long-term neurodevelopmental outcome of neonates with hypernatremic dehydration. Breastfeeding Medicine, 12, 163-168.

COUNSELL, S. J. & BOARDMAN, J. P. Differential brain growth in the infant born preterm: current knowledge and future developments from brain imaging. Seminars in Fetal and Neonatal Medicine, 2005. Elsevier, 403-410.

DANZER, E., GERDES, M., D'AGOSTINO, J. A., BERNBAUM, J., SIEGLE, J., HOFFMAN, C., RINTOUL, N. E., LIECHTY, K. W., FLAKE, A. W. & ADZICK, N. S. 2010. Prospective, interdisciplinary

follow-up of children with prenatally diagnosed giant omphalocele: short-term neurodevelopmental outcome. Journal of pediatric surgery, 45, 718-723.

LEE, S., MIN, J.-Y., KIM, B., HA, S.-W., HAN, J. H. & MIN, K.-B. 2021. Serum sodium in relation to various domains of cognitive function in the elderly US population. BMC geriatrics, 21, 328.

LU, C., BLACK, M. M. & RICHTER, L. M. 2016. Risk of poor development in young children in low-income and middle-income countries: an estimation and analysis at the global, regional, and country level. The Lancet Global Health, 4, e916-e922.

MCCOY, D. C., PEET, E. D., EZZATI, M., DANAEI, G., BLACK, M. M., SUDFELD, C. R., FAWZI, W. & FINK, G. 2016. Early childhood developmental status in low-and middle-income countries: national, regional, and global prevalence estimates using predictive modeling. PLoS medicine, 13, e1002034.

NIEHAUS, M. D., MOORE, S. R., PATRICK, P. D., DERR, L. L., LORNTZ, B., LIMA, A. A. & GUERRANT, R. L. 2002. Early childhood diarrhea is associated with diminished cognitive function 4 to 7 years later in children in a northeast Brazilian shantytown. The American journal of tropical medicine and hygiene, 66, 590-593.

PANETH, N. 1980. Hypernatremic dehydration of infancy: an epidemiologic review. American Journal of Diseases of Children, 134, 785-792.

SAHAY, M. & SAHAY, R. 2014. Hyponatremia: A practical approach. Indian journal of endocrinology and metabolism, 18, 760.

SANIA, A., SUDFELD, C. R., DANAEI, G., FINK, G., MCCOY, D. C., ZHU, Z., FAWZI, M. C. S., AKMAN, M., ARIFEEN, S. E. & BARROS, A. J. 2019. Early life risk factors of motor, cognitive and language development: a pooled analysis of studies from low/middle-income countries. BMJ open, 9, e026449.

SHRIMANKER, I. & BHATTARAI, S. 2020. Electrolytes. StatPearls. Treasure Island (FL). StatPearls Publishing. Copyright.

SINGLA, D. R., SHAFIQUE, S., ZLOTKIN, S. H. & ABOUD, F. E. 2014. A 22-element micronutrient powder benefits language but not cognition in Bangladeshi full-term low-birth-weight children. The Journal of nutrition, 144, 1803-1810.

SPITTLE, A. J., ANDERSON, P. J., LEE, K. J., FERRETTI, C., EELES, A., ORTON, J., BOYD, R. N., INDER, T. & DOYLE, L. W. 2010. Preventive care at home for very preterm infants improves infant and caregiver outcomes at 2 years. Pediatrics, 126, e171-e178.

TERRY, J. 1994. The major electrolytes: sodium, potassium, and chloride. Journal of Infusion Nursing, 17, 240-247.

WECHSLER, D. 1967. Manual for the Wechsler preschool and primary scale of intelligence. (No Title).

WECHSLER, D. 2002. Wechsler Primary and Preschool Scale of IntelligenceTM, 3rd Edn (WPPSITM-III). San Antonio, TX: Harcourt Assessment Services.




How to Cite

Huq, S., Sarker, S. A., Jahan, K., & Shaheen, N. (2023). LONG-TERM DEVELOPMENTAL ASSESSMENT OF CHILDREN RECOVERED FROM HYPERNATREMIA. Bioresearch Communications - (BRC), 10(01), 1386–1392. https://doi.org/10.3329/brc.v10i1.70667



Original Article