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Dysnatremia in extremely low birth weight infants is associated with multiple adverse outcomes

Journal of Perinatology volume 39, pages 842–847 (2019)Cite this article

Subjects

Abstract

Objective

The objective of this study is to discern patterns of serum sodium in a broad cohort of extremely low birth weight (ELBW) infants and associate those patterns with hospital outcomes.

Study Design

Retrospective cohort study of ELBW infants from 323 neonatal intensive care units (NICUs) discharged from 2004 to 2014. We included patients who survived at least 7 days and had daily sodium levels available, and categorized infants by their minimum and maximum sodium levels.

Results

We identified 26,871 infants of whom 12,428 met inclusion criteria. Only 1964 (15.8%) maintained eunatremia for the first week. We found most dysnatremias to be associated with increased overall mortality compared with eunatremic patients including moderate hyponatremia (12.9% vs. 8.6%, p < 0.05) and severe hypernatremia (34.8% vs. 8.6%, p < 0.001). Most of these associations were maintained after regression modeling for mortality.

Conclusion

Sodium fluctuations occurring within the first week of life are associated with increased mortality.

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References

  1. Van Marter LJ, Leviton A, Allred EN, Pagano M, Kuban KC. Hydration during the first days of life and the risk of bronchopulmonary dysplasia in low birth weight infants. J Pediatr. 1990;116:942–9.

    Article  Google Scholar 

  2. Costarino AT, Gruskay JA, Corcoran L, Polin RA, Baumgart S. Sodium restriction versus daily maintenance replacement in very low birth weight premature neonates: a randomized, blind therapeutic trial. J Pediatr. 1992;120:99–106.

    Article  Google Scholar 

  3. Tammela OK, Koivisto ME. Fluid restriction for preventing bronchopulmonary dysplasia? Reduced fluid intake during the first weeks of life improves the outcome of low-birth-weight infants. Acta Paediatr. 1992;81:207–12.

    Article  CAS  Google Scholar 

  4. Oh W, Poindexter BB, Perritt R, Lemons JA, Bauer CR, Ehrenkranz RA, et al. Association between fluid intake and weight loss during the first ten days of life and risk of bronchopulmonary dysplasia in extremely low birth weight infants. J Pediatr. 2005;147:786–90.

    Article  Google Scholar 

  5. Bell EF, Warburton D, Stonestreet BS, Oh W. Effect of fluid administration on the development of symptomatic patent ductus arteriosus and congestive heart failure in premature infants. N Engl J Med. 1980;302:598–604.

    Article  CAS  Google Scholar 

  6. Bell EF, Warburton D, Stonestreet BS, Oh W. High-volume fluid intake predisposes premature infants to necrotising enterocolitis. Lancet. 1979;2:90.

    Article  CAS  Google Scholar 

  7. Oh W. Fluid and electrolyte management of very low birth weight infants. Pediatr Neonatol. 2012;53:329–33.

    Article  Google Scholar 

  8. Hartnoll G. Basic principles and practical steps in the management of fluid balance in the newborn. Semin Neonatol. 2003;8:307–13.

    Article  Google Scholar 

  9. Dalton J, Dechert RE, Sarkar S. Assessment of association between rapid fluctuations in serum sodium and intraventricular hemorrhage in hypernatremic preterm infants. Am J Perinatol. 2015;32:795–802.

    Article  Google Scholar 

  10. Baraton L, Ancel PY, Flamant C, Orsonneau JL, Darmaun D, Roze JC. Impact of changes in serum sodium levels on 2-year neurologic outcomes for very preterm neonates. Pediatrics. 2009;124:e655–61.

    Article  Google Scholar 

  11. Walker MW, Clark RH, Spitzer AR. Elevation in plasma creatinine and renal failure in premature neonates without major anomalies: terminology, occurrence and factors associated with increased risk. J Perinatol. 2011;31:199–205.

    Article  CAS  Google Scholar 

  12. Baumgart S, Langman CB, Sosulski R, Fox WW, Polin RA. Fluid, electrolyte, and glucose maintenance in the very low birth weight infant. Clin Pediatr. 1982;21:199–206.

    Article  CAS  Google Scholar 

  13. Fanaroff AA, Wald M, Gruber HS, Klaus MH. Insensible water loss in low birth weight infants. Pediatrics. 1972;50:236–45.

    CAS  PubMed  Google Scholar 

  14. Gawlowski Z, Aladangady N, Coen PG. Hypernatraemia in preterm infants born at less than 27 weeks gestation. J Paediatr Child Health. 2006;42:771–4.

    Article  Google Scholar 

  15. Elliott HC, Holley HL. Serum sodium and potassium values in 400 normal human subjects, determined by the Beckman flame photometer. Am J Clin Pathol. 1951;21:831–5.

    Article  Google Scholar 

  16. Burtis CA, Ashwood ER, Bruns DE, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 5th ed. St. Louis, Missouri: Elsevier Saunders; 2011.

    Google Scholar 

  17. Spath C, Sjostrom ES, Ahlsson F, Agren J, Domellof M. Sodium supply influences plasma sodium concentration and the risk of hyper- and hyponatremia in extremely preterm infants. Pediatr Res. 2017;81:455–60.

    Article  Google Scholar 

  18. Al-Dahhan J, Haycock GB, Nichol B, Chantler C, Stimmler L. Sodium homeostasis in term and preterm neonates: III. Effect of salt supplementation. Arch Dis Child. 1984;59:945–50.

    Article  CAS  Google Scholar 

  19. Al-Dahhan J, Jannoun L, Haycock GB. Effect of salt supplementation of newborn premature infants on neurodevelopmental outcome at 10–13 years of age. Arch Dis Child Fetal Neonatal Ed. 2002;86:F120–3.

    Article  CAS  Google Scholar 

  20. Kim YJ, Lee JA, Oh S, Choi CW, Kim EK, Kim HS, et al. Risk factors for late-onset hyponatremia and its influence on neonatal outcomes in preterm infants. J Korean Med Sci. 2015;30:456–62.

    Article  Google Scholar 

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Acknowledgements

We thank Dr. Roy Haas for his contribution with initial data analysis. We thank Dr. Reese Clark for his critical feedback on this manuscript. The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Air Force and Army, Department of Defense, or the U.S. Government.

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Authors and Affiliations

  1. Department of Pediatrics, Naval Medical Center Portsmouth, Portsmouth, VA, USA

    Christopher S. Monnikendam

  2. Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX, USA

    Thornton S. Mu & Nicholas R. Carr

  3. Department of Graduate Medical Education, Brooke Army Medical Center, San Antonio, TX, USA

    James K. Aden

  4. Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI, USA

    William Lefkowitz

  5. Pediatrix Medical Group, San Antonio, TX, USA

    Christine N. Aune & Kaashif A. Ahmad

Authors
  1. Christopher S. Monnikendam
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  2. Thornton S. Mu
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  3. James K. Aden
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  4. William Lefkowitz
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  5. Nicholas R. Carr
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  6. Christine N. Aune
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Correspondence to Thornton S. Mu.

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Monnikendam, C.S., Mu, T.S., Aden, J.K. et al. Dysnatremia in extremely low birth weight infants is associated with multiple adverse outcomes. J Perinatol 39, 842–847 (2019). https://doi.org/10.1038/s41372-019-0359-0

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