Neurodevelopmental consequences of early plasma sodium changes in very preterm infants

Abstract

Background Sodium fluctuations in very preterm neonates and their neurodevelopmental consequences are not well described. Methods We assessed the changes in plasma sodium and glucose in the first days of life in very preterm neonates and studied the association of glucose-corrected plasma sodium fluctuations on neurodevelopmental outcomes. We included 147 consecutive neonates born before 29 weeks of gestation in our center and retrospectively obtained plasma sodium, glucose, and glucose-corrected sodium levels. Neurodevelopmental assessment was obtained from the Canadian Neonatal Follow-Up Network. Results Mean ± standard deviation of plasma sodium changes within the first 10 days of life were 16.2 ± 6.0, 14.8 ± 5.3, and 11.1 ± 5.2 mmol/l in neonates born ≤25, 25–26, and 26–27 weeks of gestation, respectively ( p < 0.001). Non-steroidal anti-inflammatory drug administration was associated with larger plasma sodium fluctuation. Eighty-six percent had a known neurological status at 18 months. Higher fluctuations in glucose-corrected plasma sodium were associated with death or neurodevelopmental impairment at 18 months corrected age ( B = 3.19, 95% CI [1.24, 5.14]), and this association remained after adjustment for gestational age ( B = 2.1, 95% CI [0.16, 4.04]). Conclusions Neonates born very preterm show fluctuations in glucose-corrected plasma sodium during the first days of life, which may increase the risk of death or developmental impairment. Impact Risk factors and neurodevelopmental consequences of plasma sodium changes in early neonatal life of preterm infants are not well characterized. This study shows for the first time that glucose-corrected plasma sodium fluctuations within the first days of life are more severe in preterm infants receiving non-steroidal anti-inflammatory drugs (NSAIDs) and are associated with death or neurodevelopmental impairment at 18 months corrected age. Large plasma sodium and glucose fluctuations should be expected more often in preterm infants receiving NSAIDs and should be avoided.

Sodium and Growth in Preterm Infants: A Review

“…The importance of sodium homeostasis in optimizing additional outcomes of preterm infants has been highlighted by other investigators. Both hyper-and hyponatremia in the first week of postnatal life have been associated with increased mortality, risk of intraventricular hemorrhage, and neurodevelopmental impairment, [32][33][34][35] Interestingly, children born prematurely and supplemented to sodium intakes of 4-5 mEq/kg/d for days 4-14 of postnatal life had significantly improved neurodevelopmental performance (motor function, performance IQ, the general memory index) at 10-13 years of age compared to infants receiving 1-1.5 mEq/kg/d. 36 Whether the potential effects of sodium on neurocognitive development and brain growth are separate from those on somatic growth is not known.…”

Gratitude, fragility and strength: Perspectives of adults born preterm about prematurity

“…Briefly, all individuals born preterm at any of the three main neonatal intensive care units in Montreal between 1987 and 1996 were eligible. The following outcomes were available for all participants: neonatal complications, follow‐up evaluation, presence of cerebral palsy, anthropometric measures, blood pressure, pulmonary function tests, oral glucose challenge and lipid profile, as previously described 5,12–14 . The presence of criteria for hypertension, adiposity, airflow limitation and glucose intolerance were noted, 11 and a count of those adverse outcomes (range 0–4) was used to reflect the health condition of each participant.…”

“…The following outcomes were available for all participants: neonatal complications, follow-up evaluation, presence of cerebral palsy, anthropometric measures, blood pressure, pulmonary function tests, oral glucose challenge and lipid profile, as previously described. 5,[12][13][14] The presence of criteria for hypertension, adiposity, airflow limitation and…”

Increasing Sodium Variability in the First 96 Hours after Birth is Associated with Adverse In-Hospital Outcomes of Preterm Newborns

“…These variables were selected because of their known association with alterations in serum sodium values, GA [ 26 ], SGA [ 27 ], urine output [ 5 ], daily fluid intake [ 28 ], and glucose values [ 29 ] or likelihood of reflecting higher severity of illness (i.e., vasopressor use). Previous research has shown associations of neonatal outcomes and sex, with male infants having higher rates of mortality and respiratory comorbidities; therefore, we included sex as a potential confounder [ 30 ].…”