Sodium intake and preterm babies.

Modi, Neena

doi:10.1136/adc.69.1_spec_no.87

Cited by 26 publications

(22 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Loss of body water was not related to the volume of fluid administered. This supports the view that postnatal body water loss is physiological and occurs in healthy babies as well as in babies with RDS 17. Our study also shows that restricting fluid intake in babies with RDS is both unnecessary and detrimental, as restriction of nutritional intake is an inevitable consequence of fluid restriction.…”

Section: Discussionsupporting

confidence: 89%

See 1 more Smart Citation

Influence of respiratory distress syndrome on body composition after preterm birth

Tang

Ridout

Modi

1997

Archives of Disease in Childhood - Fetal and Neonatal Edition

View full text Add to dashboard Cite

Aim-To observe changes in body composition during the first week after birth, in preterm neonates with and without respiratory distress syndrome (RDS), so as to be able to provide optimal fluid and energy intake. Methods-Twenty four babies with RDS and 19 healthy preterm babies, with gestational ages ranging from 26-36 weeks, were studied daily for the first week after birth. Total body water (TBW) was measured using bioelectrical impedance analysis. The babies were weighed daily and a record made of fluid and energy intake. Body solids were calculated as the diVerence between body weight and TBW. Results-There was a highly significant reduction in body weight by the end of the week, with the RDS babies losing more than the healthy babies (RDS 7.6%; non-RDS 3.7%). There was no significant diVerence in the amount of TBW at birth in the babies with and without RDS (RDS 85.1%; non-RDS 85.5%) and both groups lost the same amount of body water (RDS 10.9%; non-RDS 9.9%) by the end of the first week. The amount of total body water lost was unrelated to the volume of fluid administered. There was a loss of body solids during the first day in the RDS group, but, overall, there was a highly significant increase in both groups between birth and day 7, which was greater in the healthy babies (RDS 13.0%; non-RDS 42.7%). Conclusions-Loss of body water after birth occurs to the same extent in healthy preterm neonates and in babies with RDS and is unrelated to the volume of fluid administered. Given adequate nutritional support, an increase in body solids can accompany early postnatal weight loss and begins almost immediately after birth, in both healthy preterm babies and babies with RDS. (Arch Dis Child 1997;77:F28-F31)

show abstract

Section: Discussionsupporting

confidence: 89%

“…In this study none of the subjects had extremely severe RDS or went on to develop chronic lung disease, both of which have been associated with a failure to show early loss of body water and loss weight after birth 58This is probably related to an inappropriate early sodium intake rather than excessive fluid volumes 17…”

Section: Discussionmentioning

confidence: 63%

Influence of respiratory distress syndrome on body composition after preterm birth

Tang

Ridout

Modi

1997

Archives of Disease in Childhood - Fetal and Neonatal Edition

View full text Add to dashboard Cite

show abstract

“…We did not find any statistically significant difference in the incidence of renal failure between our groups. We defined renal failure as a low urine output11 and a serum creatinine concentration greater than 132 μmol/l 89Recently it has been suggested that the plasma creatinine rises to a peak in the first 48 hours after birth in preterm infants 16.…”

Section: Discussionmentioning

confidence: 99%

“…The clinicians were allowed to deviate from the recommended fluid regimen if renal impairment, hypotension, or jaundice occurred. Infants who developed acute renal failure—that is, for any 24 hour period, creatinine levels > 132 μmol/l9 10 and urine output < 1.0 ml/kg/hour, except on day 1 when the urine output had to be < 0.5 ml/kg/hour11—without evidence of dehydration were restricted to a fluid input equal to their urine output plus insensible losses. Infants who were hypotensive (mean blood pressure less than the 10th centile for their gestational age and birth weight12) were prescribed up to two boluses of colloid or crystalloid and then an inotrope infusion.…”

Section: Methodsmentioning

confidence: 99%

Randomised trial of fluid restriction in ventilated very low birthweight infants

Kavvadia

2000

Archives of Disease in Childhood - Fetal and Neonatal Edition

View full text Add to dashboard Cite

Background-Fluid restriction has been reported to improve survival of infants without chronic lung disease (CLD), but it remains unknown whether it reduces CLD in a population at high risk of CLD routinely exposed to antenatal steroids and postnatal surfactant without increasing other adverse outcomes. Aim-To investigate the impact of fluid restriction on the outcome of ventilated, very low birthweight infants. Study design-A randomised trial of two fluid input levels in the perinatal period was performed. A total of 168 ventilated infants (median gestational age 27 weeks (range 23-33)) were randomly assigned to receive standard volumes of fluid (60 ml/kg on day 1 progressing to 150 ml/kg on day 7) or be restricted to about 80% of standard input. Results-Similar proportions of infants on the two regimens had CLD beyond 28 days (56% v 51%) and 36 weeks post conceptional age (26% v 25%), survived without oxygen dependency at 28 days (31% v 27%) and 36 weeks post conceptional age (58% v 52%), and developed acute renal failure. There were no statistically significant diVerences between other outcomes, except that fewer of the restricted group (19% v 43%) required postnatal steroids (p < 0.01). In the trial population overall, duration of oxygen dependency related significantly to the colloid (p < 0.01), but not crystalloid, input level; after adjustment for specified covariates, the hazard ratio was 1.07 (95% confidence interval 1.02 to 1.13). Conclusions-In ventilated, very low birthweight infants, fluid restriction in the perinatal period neither reduces CLD nor increases other adverse outcomes. Colloid infusion, however, is associated with increased duration of oxygen dependency. (Arch Dis Child Fetal Neonatal Ed 2000;83:F91-F96) Keywords: chronic lung disease; prematurity; very low birthweight; fluid restriction; lungs; survival High volumes of fluid input increase the likelihood of a patent ductus arteriosus (PDA), 1 a known risk factor for the development of chronic lung disease (CLD).2 It is therefore surprising that fluid restriction in only one 3 of four 1 3-5 randomised trials was associated with improved outcome. Interestingly, the positive eVect was a lower mortality rather than a lower CLD rate.3 The population investigated were relatively mature and it is not clear how many were exposed to antenatal steroids or postnatal surfactant.3 Fluid restriction has a number of important possible side eVects, including hypovolaemia which could result in renal impairment. We therefore felt it important to determine, in a high risk population, whether fluid restriction compared with a more liberal regimen was associated with a lower incidence of CLD but no increase in other adverse outcomes. MethodsA randomised trial of two levels of fluid input was undertaken. Infants born prematurely with a birth weight of < 1500 g, without major congenital anomalies and requiring ventilation from within the first six hours of birth were eligible for entry into the study. If informed written consent was given by the pa...

show abstract

“…The timing of the loss of extracellular fluid is closely linked to cardiopulmonary adaptation and, for example, is delayed in infants with respiratory distress syndrome 3. In addition, neonates, especially if preterm, have a limited ability to excrete a sodium load 4. There are therefore justifiable concerns that early sodium supplementation, especially in preterm infants with respiratory distress syndrome, will favour persistent expansion of the extracellular compartment and retention of interstitial fluid.…”

mentioning

confidence: 99%

Randomised controlled trial of postnatal sodium supplementation on oxygen dependency and body weight in 25-30 week gestational age infants

Hartnoll

Bétrémieux

Modi

2000

Archives of Disease in Childhood - Fetal and Neonatal Edition

View full text Add to dashboard Cite

Aim-To compare the eVects of early against delayed sodium supplementation on oxygen dependency and body weight, in preterm infants of 25-30 weeks of gestational age. Methods-Infants were stratified by gender and gestation and randomly assigned to receive a sodium intake of 4 mmol/kg/ day starting on either the second day after birth or when weight loss of 6% of birthweight was achieved. Daily sodium intake, serum sodium concentration, total fluid intake, energy intake, clinical risk index for babies (CRIB) score and duration of ventilatory support and additional oxygen therapy were recorded. Infants were weighed daily. Weights at 36 weeks and six months of postmenstrual age were also recorded. Results-Twenty four infants received early, and 22 delayed, sodium supplementation. There were no significant diVerences in total fluid and energy intake between the two groups. There was a significant diVerence in oxygen requirement at the end of the first week, with 9% of the early group in air in contrast to 35% of the delayed group (diVerence 26%, 95% confidence interval 2, 50). At 28 days after birth the proportions were 18% of the early group and 40% of the delayed group (diVerence 22%, 95% CI −5, 49). Proportional hazards modelling showed early sodium supplementation and lower birthweight to be significantly associated with increased risk of continuing oxygen requirement. The delayed sodium group had a greater maximum weight loss (delayed 16.1%; early 11.4%, p=0.02), but there were no significant diVerences in time to maximum weight loss, time to regain birthweight, and weight at 36 weeks and 6 months of postmenstrual age. Conclusion-In infants below 30 weeks of gestation, delaying sodium supplementation until at least 6% of birthweight is lost has a beneficial eVect on the risk of continuing oxygen requirement and does not compromise growth.

show abstract

Sodium intake and preterm babies.

Cited by 26 publications

References 49 publications

Influence of respiratory distress syndrome on body composition after preterm birth

Influence of respiratory distress syndrome on body composition after preterm birth

Randomised trial of fluid restriction in ventilated very low birthweight infants

Randomised controlled trial of postnatal sodium supplementation on oxygen dependency and body weight in 25-30 week gestational age infants

Contact Info

Product

Resources

About