Hypernatremia and grade III/IV intraventricular hemorrhage among extremely low birth weight infants

Abstract

Objective: To identify the risk factors contributing to intraventricular hemorrhage (IVH) in extremely low birth weight infants during early postnatal life, after appropriate matching for gestational age (GA) and birth body weight (BBW).Study Design: A case-control retrospective study was designed to evaluate preterm infants with a GA p26 weeks and a BBW p1000 g admitted to our hospital during a 7.5-year period. From a cohort of 347 preterm infants, 36 infants (10.7%) had severe IVH (grades III and/or IV). We selected a control group of 36 preterm infants without IVH who were closely matched for GA ( ± 1 week) and body weight ( ± 100 g). Univariate and multivariate logistic regression analyses were performed to identify risk factors for severe IVH. Result:The GA and BBW of the IVH and control groups were 24.6 ± 1weeks and 764.4 ± 118.5 g, and 24.8 ± 0.9 weeks and 771.5 ± 125.9 g, respectively. Vaginal delivery, male sex, resuscitation in the delivery room, high sodium serum levels (meq l À1 ) (162.6 vs 148.8), fluctuation of serum sodium (meq l À1 ) (17.3 vs 6.2), pH, PaCO 2 , hemoglobin and platelet counts were associated with an increased risk of severe IVH. Multivariate logistic regression indicated that sodium fluctuations >13 meq l À1 , vaginal delivery, male sex and hemoglobin fluctuations are strongly associated with the development of severe IVH.Conclusion: Hypernatremia and fluctuations of sodium seem to be related to early severe IVH among preterm infants; however, further studies are required to clarify the causal relationship.

Sobrevida e morbidade em prematuros com menos de 32 semanas de gestação na região central do Brasil

“…O diagnóstico de leucomalácia cística, ao contrário, não diferiu entre os grupos, embora tenha ocorrido apenas nos grupos de menor IG (grupos G25 e G28). Apesar da incidência de hemorragia intraventricular grave estar decrescendo nas últimas décadas, essa doença ainda permanece como importante fator de risco para mortalidade e morbidade em prematuros extremos 32 . A incidência de hemorragia intraventricular grave gira em torno de 6 a 10%, em prematuros extremos, e a leucomalácia cística ocorre em torno de 5 a 6% 22,24 .…”

“…A incidência de hemorragia intraventricular grave gira em torno de 6 a 10%, em prematuros extremos, e a leucomalácia cística ocorre em torno de 5 a 6% 22,24 . Em recente estudo com prematuros menores do que 1.000 g e IG menor ou igual a 26 semanas, a incidência de hemorragia intraventricular grave foi de 10,7% e a taxa de mortalidade, nesse grupo, foi 47,2%, muito acima da observada no Grupo Controle (13,9%) 32 . Quando se compara os resultados do estudo atual com dados de outros serviços, observa-se que a incidência de hemorragia intraventricular grave está acima do esperado, o que aponta para a necessidade de aprimorar os cuidados oferecidos a esses pacientes, bem como de controle mais cuidadoso dos fatores de risco associados à lesão cerebral, como a sepse neonatal, que foi elevada neste estudo.…”

Parenteral Nutrition in Premature Infants

“…Additionally, excessive urine output above 5 mL/kg/h needs to be rapidly compensated volume for volume with 0.45 % sodium chloride infusion to balance water and sodium losses. Excessive sodium intakes from medications should be controlled to avoid any sodium overload and hypernatremia [54,[76][77][78]. In VLBW infants, urine sodium fractional excretion is high due to immature kidney functions.…”

“…Therefore, fluid and electrolytes disturbances are frequently observed and are associated with increased morbidity, mortality, and adverse developmental outcomes, especially in VLBW infants [54,[73][74][75]. In particular, dehydration (weight loss above 10 %) combined with or without inadvertent increase sodium intake frequently induces severe hypernatremia above 150 mmol/L and brain injuries [54,74,[76][77][78]. On the other hand, excessive water intake and relative hyponatriemia below 130 mmol/L might also compromise cardio-respiratory functions and induce brain injuries in premature infants.…”

Assessment of Association between Rapid Fluctuations in Serum Sodium and Intraventricular Hemorrhage in Hypernatremic Preterm Infants

“…4,13,14 In addition to the degree of hypernatremia, rapid correction of serum sodium has been reported to increase the risk of severe neurologic complications in hypernatremic infants. 15 Indeed, based on the data from children and adults a serum sodium correction rate of less than 0.5 mmol/L/h or 10 mmol/L/d provides better outcomes, 8,15,16 and it has been emphasized that the maximum rate of decrease of the serum sodium level in term neonates with hypernatremic dehydration should not exceed 0.6 mmol/L/h or 15 mmol/L/d 17 ; however, the appropriate rate to reduce the serum sodium during correction of hypernatremia in the preterm population is not known.…”