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Somatic growth outcomes in response to an individualized neonatal sodium supplementation protocol

Journal of Perinatology volume 45, pages 305–311 (2025)Cite this article

Subjects

Abstract

Objective

Evaluate the impact of a sodium (Na) supplementation protocol based upon urine Na concentration on growth parameters and morbidities.

Study design

Retrospective cohort study of infants 260/7-336/7 weeks gestational age (GA) cared for before (2012–15, n = 310) and after (2016–20, n = 382) implementation of the protocol. Within- and between-group changes over time were assessed using repeated measures generalized linear models.

Results

For infants 260/7-296/7 weeks GA, utilization of the protocol was associated with increased mean body weight z-score at 8-weeks postnatal age, increased mean head circumference z-score at 16-weeks postnatal age, and decreased time on mechanical ventilation (all p < 0.02). No impact on growth was identified for infants 30–336/7 weeks GA. Incidences of hypertension, hypernatremia, bronchopulmonary dysplasia, necrotizing enterocolitis, and culture positive sepsis were unaffected by the protocol.

Conclusion

Protocolized Na supplementation is associated with improved growth and reduced time on invasive mechanical ventilation in extremely preterm infants without increasing incidence of morbidities.

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Data availability

The dataset generated and analyzed during the current study is not publicly available due to protection of patient privacy but is available from the corresponding author upon reasonable request.

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Funding

L.H. receives support from NIH/NIDDK R01DK128835. E.Steinbach receives support from the NIH/NIDDK T32DK007690-29. J.S. receives support from NIH/NIDDK R01DK133197 and NIH/NIDDK R01DK133121. P.T.E. and L.W. receive support from the NIH CTSA program grant UM1TR004403. This content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Author information

Author notes

  1. These authors contributed equally: Jeffrey L. Segar, Lyndsay A. Harshman.

Authors and Affiliations

  1. Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa, IA, USA

    Elliot J. Stalter, Silvia L. Verhofste, John M. Dagle, Emily J. Steinbach & Lyndsay A. Harshman

  2. Institute for Clinical and Translational Science, University of Iowa, Iowa, IA, USA

    Patrick Ten Eyck & Linder Wendt

  3. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA

    Jeffrey L. Segar

  4. Iowa Neuroscience Institute, University of Iowa, Iowa, IA, USA

    Lyndsay A. Harshman

Authors
  1. Elliot J. Stalter
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  2. Silvia L. Verhofste
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  4. Emily J. Steinbach
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  6. Linder Wendt
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  7. Jeffrey L. Segar
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  8. Lyndsay A. Harshman
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Contributions

E. Stalter, S.V., E. Steinbach, L.H., and J.S. conceptualized and designed the current study. E. Stalter, S.V., and E. Steinbach were involved in data curation, and P.T.E. and L.W. were involved in the analysis and interpretation of data. J.D., J.S. and L.H. conceptualized the original protocol. All authors contributed to the critical review of this work.

Corresponding author

Correspondence to Lyndsay A. Harshman.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

All methods were performed in accordance with relevant guidelines and regulations. Review of patient data was approved with waived consent by the University of Iowa Institutional Review Board (202203591) due to the retrospective nature of the study.

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Stalter, E.J., Verhofste, S.L., Dagle, J.M. et al. Somatic growth outcomes in response to an individualized neonatal sodium supplementation protocol. J Perinatol 45, 305–311 (2025). https://doi.org/10.1038/s41372-024-02141-9

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