Sodium intake and intraventricular hemorrhage in the preterm infant

Abstract

Increasing intake of sodium appears to be a modifiable risk factor for intraventricular hemorrhage in very low birth weight infants.

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

“…23,24 This study also reinforces the previous observation of an independent association of hypernatremia in the 1st week of life with the development of IVH. 4,13,14 The ELBW infants were more susceptible to IVH probably during an extended period of physiologic instability after premature birth because of abundant but fragile blood vessels in the brain. 25 Indeed, the infants who developed IVH tended to have lower GA, were products of a multiple gestation, and were born to mothers with histopathologic chorioamnionitis, consistent with the literature.…”

“…This study, like other previous studies, suggests that meticulous fluid and electrolyte management in ELBW infants can decrease the incidence of hypernatremia-related IVH, and improve outcomes in such infants. 13,14 This study was not designed to investigate the causes of hypernatremia or to evaluate any specific protocol to prevent or treat hypernatremic dehydration. We rather analyzed the cohort of hypernatremic ELBW infants in this observational study to assess the independent relationship between the rapid fluctuations in serum sodium and IVH, or death in preterm infants who had developed hypernatremia, whatever the reason may be during the first 10 days of life.…”

“…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.…”

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.…”