Aims-To compare the eVects of early and delayed sodium supplementation on body composition and body water compartments during the first two weeks of postnatal life. Methods-Preterm infants of 25-30 weeks' gestation were stratified and randomly assigned according to gender and gestational age, to receive a sodium intake of 4 mmol/kg/day beginning either on the second day after birth or when weight loss of 6% of birthweight had been achieved. Daily sodium intake, total fluid intake, energy intake, urine volume, and urinary sodium excretion were recorded. Total body water was measured by H 2 18 O dilution on days 1, 7, and 14, and extracellular fluid volume by sodium bromide dilution on days 1 and 14. Results-Twenty four infants received early, and 22 delayed, sodium supplementation. There were no significant diVerences between the groups in body water compartments on day 1. In the delayed group, but not the early group, there was a significant loss of total body water during the first week (delayed −44 ml/kg, p=0.048; early 6 ml/kg, p=0.970). By day 14 the delayed, but not the early group, also had a significant reduction in extracellular fluid volume (delayed −53 ml/kg, p=0.01; early −37 ml/kg, p=0.2). These changes resulted in a significant alteration in body composition at the end of the first week (total body weight: delayed 791 ml/kg; early 849 ml/kg, p=0.013). By day 14 there were once again no significant diVerences in body composition between the two groups. Conclusions-Body composition after preterm birth is influenced by the timing of introduction of routine sodium supplements. Early sodium supplementation can delay the physiological loss of body water that is part of normal postnatal adaptation. This is likely to be of particular relevance to babies with respiratory distress syndrome. A tailored approach to clinical management, delaying the introduction of routine sodium supplements until there has been postnatal loss of body water, is recommended. (Arch Dis Child Fetal Neonatal Ed 2000;82:F24-F28)
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.
A case of ingestion of oil of cloves is presented, which resulted in coma, fits, a coagulopathy, and acute liver damage. This is not unlike the syndrome produced in the late stages ofa substantial paracetomol overdose, and a similar treatment regimen is proposed.
Background-Preterm birth is often associated with impaired growth. Small for gestational age status confers additional risk. Aim-To determine the body water content of appropriately grown (AGA) and small for gestational age (SGA) preterm infants in order to provide a baseline for longitudinal studies of growth after preterm birth. Methods-All infants born at the Hammersmith and Queen Charlotte's Hospitals between 25 and 30 weeks gestational age were eligible for entry into the study. Informed parental consent was obtained as soon after delivery as possible, after which the extracellular fluid content was determined by bromide dilution and total body water by H 2 18O dilution. Results-Forty two preterm infants were studied. SGA infants had a significantly higher body water content than AGA infants (906 (833-954) and 844 (637-958) ml/kg respectively; median (range); p = 0.019). There were no diVerences in extracellular and intracellular fluid volumes, nor in the ratio of extracellular to intracellular fluid. Estimates of relative adiposity suggest a body fat content of about 7% in AGA infants, assuming negligible fat content in SGA infants and lean body tissue hydration to be equivalent in the two groups. Conclusions-Novel values for the body water composition of the SGA preterm infant at 25-30 weeks gestation are presented. The data do not support the view that SGA infants have extracellular dehydration, nor is their regulation of body water impaired. (Arch Dis Child Fetal Neonatal Ed 2000;83:F56-F59)
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