Sodium supply influences plasma sodium concentration and the risks of hyper- and hyponatremia in extremely preterm infants

Späth, Cornelia; Sjöström, Elisabeth Stoltz; Ahlsson, Fredrik; Ågren, Johan; Domellöf, Magnus

doi:10.1038/pr.2016.264

Cited by 32 publications

(30 citation statements)

References 27 publications

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“…Our study shows a linear relationship between peak sodium and GA in patients born between 24 and < 31 weeks. This extends previous results, showing a similar relationship in patients < 27 weeks GA [22], to a wider range of GA. The physiological mechanisms leading to the observed increase in sodium during the first days of life are most likely based on the postnatal changes of body composition, which occurs due to a significant reduction in extracellular water and reduction of total body water caused by pulmonary and transepidermal insensible water loss.…”

Section: Discussionsupporting

confidence: 91%

“…Therefore, it is important to identify patients at risk and to monitor sodium closely in these patients. Since hypernatremia is either caused by an excess of sodium or by lack of body water, these parameters can be targeted easily by either reducing sodium administration [22], by increasing free body water [5] or by decreasing insensible water loss [7]. In adults it has been shown that targeting sodium and aiming at normal sodium levels leads to decreased morbidity and mortality [8].…”

Section: Discussionmentioning

confidence: 99%

“…Hypernatremia is defined by plasma sodium concentrations > 145 mmol/l and is a common complication in preterm neonates during their first days of life. Up to 50-70 % of preterm neonates with a gestational age (GA) < 27 weeks develop hypernatremia [13,22]. In preterm neonates hypernatremia is associated with severe clinical complications such as intraventricular hemorrhage (IVH) and can lead to impaired neurodevelopmental outcome [1].…”

Section: Introductionmentioning

confidence: 99%

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Vaginal Delivery and Low Gestational Age are Key Risk Factors for Hypernatremia in Neonates<32 Weeks

et al. 2021

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Background Preterm neonates frequently experience hypernatremia (plasma sodium concentrations >145 mmol/l), which is associated with clinical complications, such as intraventricular hemorrhage. Study design In this single center retrospective observational study, the following 7 risk factors for hypernatremia were analyzed in very low gestational age (VLGA, below 32 weeks) neonates: gestational age (GA), delivery mode (DM; vaginal or caesarian section), sex, birth weight, small for GA, multiple birth, and antenatal corticosteroids. Machine learning (ML) approaches were applied to obtain probabilities for hypernatremia. Results 824 VLGA neonates were included (median GA 29.4 weeks, median birth weight 1170 g, caesarean section 83%). 38% of neonates experienced hypernatremia. Maximal sodium concentration of 144 mmol/l (interquartile range 142–147) was observed 52 hours (41–65) after birth. ML identified vaginal delivery and GA as key risk factors for hypernatremia. The risk of hypernatremia increased with lower GA from 22% for GA ≥ 31–32 weeks to 46% for GA < 31 weeks and 60% for GA < 27 weeks. A linear relationship between maximal sodium concentrations and GA was found, showing decreases of 0.29 mmol/l per increasing week GA in neonates with vaginal delivery and 0.49 mmol/l/week after cesarean section. Sex, multiple birth and antenatal corticosteroids were not associated hypernatremia. Conclusion VLGA neonates with vaginal delivery and low GA have the highest risk for hypernatremia. Early identification of neonates at risk and early intervention may prevent extreme sodium excursions and associated clinical complications.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Vaginal Delivery and Low Gestational Age are Key Risk Factors for Hypernatremia in Neonates<32 Weeks

et al. 2021

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“…In 2017, Späth et al presented a postnatal weight change of −10 ± 7% (range −31% to +13%) in a cohort of 592 extremely low birthweight infants, with a nadir at a postnatal age of 4 days. They found that the average daily fluid intake on days 0‐3 after birth correlated positively with the percentage weight change from birth to day four of life . It has been proposed that, in addition to the contraction of extracellular fluid, up to half of the initial postnatal weight loss in low birthweight infants might represent failure to accrete or actual loss of lean mass and, or, fat .…”

Section: Discussionmentioning

confidence: 99%

Hidden sources like saline flushes make a significant contribution to the fluid intake of very low birthweight infants during the first postnatal week

et al. 2019

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Aim We examined actual fluid intake, and routes of administration, in very low birthweight (VLBW) infants during the first week of life in a neonatal intensive care unit. Methods This retrospective cohort study comprised 953 infants born at <32 weeks and 1500 g and treated at Helsinki University Children's Hospital from 2005 to 2013. All parenterally and enterally administered fluids, and their sources, were obtained from our patient information system. Infants were divided into three groups according to their gestational age: 23‐26, 27‐29 and 30‐31 weeks. Results Fluid intake exceeded European guidelines during the first 3 days. On days 1‐7, total fluid intake was highest in the most premature group (P < .001) and the median total fluid intake in this group peaked at 177 mL/kg/d (IQR 154‐209) on day three. Intravascular flushes provided a considerable source of fluids, with the median intake in the most preterm group peaking at 26.4 mL/kg/d, which represented 15.6% of total fluid intake. Conclusion During the first 3 days of life, our VLBW infants had a higher total fluid intake than the European guidelines. A considerable percentage came from hidden sources, such as saline flushes, which should be taken into account when prescribing fluids.

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“…After the catheter occluded on day 8, we assessed his blood pressure mainly by physical examination. The target ranges of osmotic agents were set with reference to previous studies, and his albumin level was kept above 2.5 g/dL to maintain osmotic pressure (24)(25)(26)(27). Echocardiography was performed to diagnose patent ductus arteriosus (PDA) on day 1.…”

Section: Case Descriptionmentioning

confidence: 99%

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Sodium supply influences plasma sodium concentration and the risks of hyper- and hyponatremia in extremely preterm infants

Abstract: The supply of sodium, rather than fluid volume, is the major factor determining P-Na concentrations and the risks of hyper- and hyponatremia.

Cited by 32 publications

References 27 publications

Vaginal Delivery and Low Gestational Age are Key Risk Factors for Hypernatremia in Neonates<32 Weeks

Vaginal Delivery and Low Gestational Age are Key Risk Factors for Hypernatremia in Neonates<32 Weeks

Hidden sources like saline flushes make a significant contribution to the fluid intake of very low birthweight infants during the first postnatal week

Video_1.MP4

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