The quality of parenteral nutrition (PN) in preterm infants has major effects on several outcomes including growth and neurocognitive development. Prescribing PN remains, however, a difficult task and inadvertent intakes during intensive care may be important contributors of total intakes especially in preterm infants. In this issue of Pediatric Research, the manuscript “ELBW-infants receive inadvertent sodium load above recommended intake” highlights specifically the risk of excessive sodium load in immature infants with a gestational age below 28 weeks.1 The main strength of this manuscript is that it reports, in a fairly large cohort of infants, the estimated daily intake of sodium during the first 2 weeks of life taking into account not only that from parenteral and enteral nutrition but also that from other sources such as carrier solutions and drugs that are often considered as negligible. Very interestingly, the authors show that 50−80% of the sodium provided during the first week of life is not related to nutrition per se (i.e. PN, enteral nutrition, phosphate) but to inadvertent sodium intake. They have identified that antibiotics, crystalloids and sodium bicarbonate infusions are the main sources of unrecognized sodium intake during this period. This finding is in line with previous studies reporting that inadvertent sodium or chloride intake may represent up to 70% of total intakes during the first postnatal days.2,3,4

The other interest of this manuscript is that it demonstrates that regularly assessing our practices is a necessity. This monocentric study is more a quality improvement rather than a research study. It was indeed designed to assess the nutritional care as judged by established/accepted standards and not to really develop or contribute to generalizable knowledge. The described practices in this manuscript are questionable, far from those recommended, and likely far from expected by the authors themselves when designing the study. The observed median daily sodium intake was 11 mmol/kg/d during the first week of life; in many cases, it exceeded 20 mmol/kg/d, and in few cases it ranged between 30 and 50 mmol/kg/d. Overall the values reported in this manuscript are excessive and by comparison with previous reports the median intake represents more than twice the current recommendations,5 and is much higher than the 4−5 mmol/kg/d usually provided.2,3,4,6

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