John, Sangeetha RachelRahul, AswathySujatha, Radhika2025-10-122025-10-122025https://hdl.handle.net/20.500.14572/2596Sangeetha Rachel John Senior Resident, Department of Paediatrics, SUT Academy of Medical Science Vencod, Vattappara, Thiruvananthapuram, Kerala – 695028, India. https://orcid.org/0009-0000-6798-2174 Aswathy Rahul Assistant Professor, Department of Neonatology, Government Medical College, Ulloor, Thiruvananthapuram, Kerala 695011, India. https://orcid.org/0000-0003-2125-8169 Radhika Sujatha Professor and Head of Department, Department of Neonatology, Government Medical College, Ulloor, Thiruvananthapuram, Kerala 695011, India. https://orcid.org/0000-0003-4785-3556Abstract: Neonatal hypernatremic dehydration, often resulting from suboptimal breastfeeding, is a life-threatening condition characterized by severe electrolyte imbalances. Lack of awareness about postnatal weight monitoring delays diagnosis. Severe hypernatremia (Serum sodium > 170 mEq / L) can cause acute kidney injury (AKI), disseminated intravascular coagulation (DIC), cerebral edema and death. We wanted to describe the clinical profiles, complications, and outcomes of neonates with severe hypernatremic dehydration due to suboptimal breastfeeding. The case series describes eight neonates admitted with severe hypernatremic dehydration in our NICU. All neonates were exclusively breastfed. Poor feeding was noted in 87.5% neonates. 12.5% presented in gasping respiration with severe metabolic acidosis requiring intubation, 62.5% had shock, 87% had AKI, 37.5% had seizures and 20% had intracranial bleeding. One neonate died from cerebral edema; another developed limb gangrene. This case series highlights the importance of prevention of dehydration from suboptimal breastfeeding with early postnatal weight monitoring and timely interventions.en-USBreastfeedingDehydrationHypernatremic dehydrationNeonatesArticle