Impact of Changes in Serum Sodium Levels on 2-Year Neurologic Outcomes for Very Preterm Neonates

Baraton, Louis; Ancel, Pierre‐Yves; Flamant, Cyrille; Orsonneau, Jean-Luc; Darmaun, Dominique; Rozé, Jean‐Christophe

doi:10.1542/peds.2008-3415

Cited by 66 publications

(48 citation statements)

References 22 publications

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“…15,20 Baraton et al reported that changes in serum sodium levels of more than 13 meq l À1 was significantly associated with the development of impaired functional outcomes after adjustment for GA, as well as perinatal and neonatal hospitalization characteristics. 21 Our study showed that changes in serum sodium levels of more than 13 meq l À1 were significantly associated with severe IVH, thereby providing a reasonable explanation for the findings of Baraton et al Similar to previous studies, 22,23 our results indicated that males had an increased risk of developing severe IVH. Male preterm infants had higher cerebral blood flow and a higher incidence of blood pressure change as a result of the dysregulation of dopamine, norepinephrine and serotonin levels in an animal study.…”

Section: Discussionsupporting

confidence: 89%

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

et al. 2010

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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.

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Section: Discussionsupporting

confidence: 89%

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

et al. 2010

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“…Sodium management is particularly challenging with one quarter of infants with GA of less than 33 weeks having a documented episode of hyponatremia of Na <130 mmol/l while in hospital [36]. Inevitably in a number of infants, an evolving sodium deficit remains a challenge to overcome.…”

Section: Reviewmentioning

confidence: 99%

“…Hyponatremia itself has been implicated as a noxious pro-inflammatory condition and an independent risk factor for poor neuromotor outcome at 2 years of age [36]. Somatic growth by cell proliferation is thought to be mediated via a sodium dependent Na/H antiporter system located in the cell wall which increases the action of Na/K ATPase and stimulates growth by alkalinization of the cell interior [53].…”

Section: Reviewmentioning

confidence: 99%

Renal consequences of preterm birth

et al. 2017

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BackgroundThe developmental origin of health and disease concept identifies the brain, cardiovascular, liver, and kidney systems as targets of fetal adverse programming with adult consequences. As the limits of viability in premature infants have been pushed to lower gestational ages, the long-term impact of prematurity on kidneys still remains a significant burden during hospital stay and beyond.ObjectivesThe purpose of this study is to summarize available evidence, mechanisms, and short- and long-term renal consequences of prematurity and identify nephroprotective strategies and areas of uncertainty.ResultsKidney size and nephron number are known to be reduced in surviving premature infants due to disruption of organogenesis at a crucial developmental time point. Inflammation, hyperoxia, and antiangiogenic factors play a role in epigenetic conditioning with potential life-long consequences. Additional kidney injury from hypoperfusion and nephrotoxicity results in structural and functional changes over time which are often unnoticed. Nephropathy of prematurity and acute kidney injury confound glomerular and tubular maturation of preterm kidneys. Kidney protective strategies may ameliorate growth failure and suboptimal neurodevelopmental outcomes in the short term. In later life, subclinical chronic renal disease may progress, even in asymptomatic survivors.ConclusionAwareness of renal implications of therapeutic interventions and renal conservation efforts may lead to a variety of short and long-term benefits. Adequate monitoring and supplementation of microelement losses, gathering improved data on renal handling, and exploration of new avenues such as reliable markers of injury and new therapeutic strategies in contemporary populations, as well as long-term follow-up of renal function, is warranted.

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“…Due to their renal immaturity, urine output and fractional sodium excretion might also be deregulated. 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].…”

Section: Postnatal Fluid and Electrolytes Metabolismmentioning

confidence: 99%

Parenteral Nutrition in Premature Infants

Senterre

Terrin

Curtis

et al. 2015

Textbook of Pediatric Gastroenterology, Hepatology and Nutrition

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Impact of Changes in Serum Sodium Levels on 2-Year Neurologic Outcomes for Very Preterm Neonates

Abstract: Although large and very large changes in serum sodium levels may simply reflect the severity of illness and/or the quality of care, a causal relationship with outcomes cannot be excluded. Cautious fluid and electrolyte management is recommended for very premature infants.

Cited by 66 publications

References 22 publications

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

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

Renal consequences of preterm birth

Parenteral Nutrition in Premature Infants

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