ELBW infants receive inadvertent sodium load above the recommended intake

Eibensteiner, Fabian; Laml-Wallner, Gerda; Thanhaeuser, Margarita; Ristl, Robin; Ely, Sarah; Jilma, Bernd; Berger, Angelika; Haiden, Nadja

doi:10.1038/s41390-020-0867-9

Cited by 8 publications

(24 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…15 In addition, sodium intakes are difficult to control, due to numerous sources of inadvertent sodium intake in the neonatal care unit, including through carrier solutions. 1 Inability to maintain sodium homeostasis and difficulty to control sodium intake result in large fluctuations in plasma sodium within the first days of life in premature infants, which were previously reported in different settings. 2 , 3 In our study, we also found large fluctuations in plasma sodium levels, that were more severe when GA was lower, similarly to previous research.…”

Section: Discussionmentioning

confidence: 90%

“…Second, we did not record daily intakes of electrolytes. Indeed, in the early neonatal period, a large proportion of sodium intake is inadvertently provided by various sources 1 (catheter flushes, arterial blood pressure measurements, IV drugs including antibiotics…) making a reliable collection of this data impossible in this retrospective study. Third, a small number of patients n = 22 (15%) had missing data for NSAID use.…”

Section: Discussionmentioning

confidence: 99%

“…For infants born extremely preterm (<28 weeks gestational age (GA)), the first days of extra-uterine life are associated with large fluctuations in electrolyte levels including plasma sodium levels resulting from extra-renal water and electrolyte losses and tubular immaturity, leading to difficult fluid and electrolyte management. 1 Previous research has shown large plasma sodium changes, with rapidly occurring hypernatremia and hyponatremia, during the first days of life in neonates born very or extremely preterm. 2 , 3 In the longer term, changes in neonatal plasma sodium have also been shown to be associated with bronchopulmonary dysplasia (BPD) 4 and alterations in neurodevelopment.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Neurodevelopmental consequences of early plasma sodium changes in very preterm infants

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Neurodevelopmental consequences of early plasma sodium changes in very preterm infants

et al. 2022

View full text Add to dashboard Cite

show abstract

“…A recent study (6) investigated the association between fluid and sodium status in the first 10 postnatal days and death/ BPD among infants born, they concluded that a higher CFB in the first 10 days after delivery was associated with higher odds of death/BPD among preterm infants. It has also been reported that there is an association between total sodium intake and BPD within the first 2 weeks of life among ELBW infants (7). However, no study has identified an association between early fluid overload and BPD in ELBWI.…”

Section: Influence Of Early Fluid Overload On Bronchopulmonary Dyspla...mentioning

confidence: 98%

Influence of early fluid overload on bronchopulmonary dysplasia in very low-birth-weight infants

Zhu

Liu

et al. 2022

Front. Pediatr.

View full text Add to dashboard Cite

ObjectiveThis study aimed to determine the influence of fluid overload on bronchopulmonary dysplasia (BPD) in very low-birth-weight infants (VLBWI) within 1 week after birth.MethodsThis was a retrospective case control study conducted in the Jingzhou Central Hospital. The clinical data of VLBWI (with a birth weight [BW] < 1,500 g and 26 weeks ≤ gestational age [GA] < 32 weeks) who were admitted to the neonatal intensive care unit of this hospital from January 2016 to December 2021 were analyzed retrospectively. A total of 157 cases were enrolled and divided into a BPD group (n = 60) and a non-BPD group (n = 97) according to whether BPD was present. The general condition, fluid intake, and fluid overload of the two groups of neonates within 1 week after birth were compared. The logistic regression was used to assess the association between infant characteristics and BPD. The ROC curve was used to assess how well the 7 day cumulative fluid overload predicted BPD, and to identify an optimal cut off for prediction.ResultsThe comparison of the patients' general condition revealed that the neonates in the BPD group had a younger GA, lower BW, lower 5-min Apgar score, longer duration of invasive mechanical ventilation, and higher incidence of intrauterine infections and administration of surfactants (P < 0.05). The differences in the other indicators were not statistically significant between the two groups. The logistic regression analysis revealed that a younger GA, the presence of intrauterine infection, and a 7-day cumulative fluid overload were the risk factors for the development of BPD. A ROC curve was plotted with the 7-day cumulative fluid overload as the test variable and BPD as the status variable. The area under the curve was 0.75 (95% confidence interval: 0.664–0.826, P = 0.042), with a sensitivity of 76.7% and a specificity of 70.1%, corresponding to a 7-day cumulative fluid overload of 36.2%.ConclusionA younger GA, the presence of intrauterine infection, and a 7-day cumulative fluid overload were risk factors for the development of BPD. A 7 day cumulative fluid overload threshold of 36.2% best predicted the development of BPD.

show abstract

“…13,[15][16][17][18] Interestingly, a recent retrospective analysis on this topic, while associating an inadvertently high sodium load with an increased overall morbidity in extremely low birth weight (ELBW) infants, did not find any correlation of sodium intake and sodium serum levels. 19 Three major obstacles in defining the importance of sodium homeostasis are the substantial differences in standard of care for ELBW infants between different tertiary neonatal intensive care units (NICU) as well as different time periods and the difficulty to perform prospective studies on this topic.…”

Section: Introductionmentioning

confidence: 99%

Excessive sodium supplementation but not fluid load is correlated with overall morbidity in extremely low birth weight infants

Becker,

Riedl‐Seifert

et al. 2024

JPGN rep.

View full text Add to dashboard Cite

ObjectivesSodium homeostasis in extremely low birth weight (ELBW) infants is critical. While a lack of sodium delays growth, excessive supplementation increases morbidity.MethodsWe performed a single‐center retrospective study on sodium and fluid management during the first 2 weeks of live including all ELBW infants born between June 1, 2017 and May 31, 2019.ResultsForty‐seven patients (median GA 26 + 6 weeks, median BW 845 g) were included. Mean sodium intake was above the ESPGHAN recommendation, 4.58 mmol/kg/day during the first 2 days and 1.99 mmol/kg/day during the following period. Incidence of PDA, IVH, and ROP was directly associated with sodium intake (OR 1.6, 1.3, and 1.4, respectively), but not with fluid supplementation. No association to BPD was found. The most important source for inadvertent sodium intake were 0.9% saline given by arterial lines. Sodium supplementation did not correlate directly with serum sodium levels, but a linear regression model combining sodium intake and fluid supplementation was able to predict serum sodium changes 24–48 h in advance (correlation coefficient of 0.294, p < 0.05).ConclusionsSodium application substantially exceeded ESPGHAN recommendations in ELBW infants. An excess in sodium was associated with an overall increased morbidity, justifying increased efforts to identify inadvertent sodium sources in these patients with the aim to decrease sodium excess.

show abstract

ELBW infants receive inadvertent sodium load above the recommended intake

Cited by 8 publications

References 34 publications

Neurodevelopmental consequences of early plasma sodium changes in very preterm infants

Neurodevelopmental consequences of early plasma sodium changes in very preterm infants

Influence of early fluid overload on bronchopulmonary dysplasia in very low-birth-weight infants

Excessive sodium supplementation but not fluid load is correlated with overall morbidity in extremely low birth weight infants

Contact Info

Product

Resources

About