Risk Factors and Effects of Severe Late-Onset Hyponatremia on Long-Term Growth of Prematurely Born Infants

Abstract

Purpose: Sodium is an essential nutritional electrolyte that affects growth. A low serum sodium concentration in healthy premature infants beyond 2 weeks of life is called lateonset hyponatremia (LOH). Here, we investigated the association between LOH severity and growth outcomes in premature infants. Methods: Medical records of premature infants born at ≤32 weeks of gestation were reviewed. LOH was defined as a serum sodium level <135 mEq/L regardless of sodium replacement after 14 days of life. Cases were divided into two groups, <130 mEq/L (severe) and ≥130 mEq/L (mild). Characteristics and growth parameters were compared between the two groups. Results: A total of 102 premature infants with LOH were included. Gestational age ([GA] 27.7 vs. 29.5 weeks, p<0.001) and birth weight (1.04 vs. 1.34 kg, p<0.001) were significantly lower in the severe group. GA was a risk factor of severe LOH (odds ratio [OR], 1.328, p=0.022), and severe LOH affected the development of bronchopulmonary dysplasia (OR, 2.950, p=0.039) and led to a poor developmental outcome (OR, 9.339, p=0.049). Growth parameters at birth were lower in the severe group, and a lower GA and sepsis negatively affected changes in growth for 3 years after adjustment for time. However, severe LOH was not related to growth changes in premature infants. Conclusion: Severe LOH influenced the development of bronchopulmonary dysplasia and developmental outcomes. However, LOH severity did not affect the growth of premature infants beyond the neonatal period.

Incidence of Hyponatremia and Associated Factors in Preterm Infants in Saudi Arabia

“…Another study found sodium to stimulate cell proliferation and also play a role in protein turnover; thus, it can be considered a significant growth factor [22]. In contrast to our findings, a recent study reported that LOH does not affect the future growth of premature neonates [23].…”

Clinical Phenotypes of Malnutrition in Young Children: Differential Nutritional Correction

“…Таким образом, признано, что детям с БЛД необходимо на 15-20% больше энергии, чем недоношенным без БЛД -в диапазоне 120-150 ккал/кг/сут; но при активном течении (обострении) БЛД -не менее 140 ккал/кг/сут, причем в относительно небольшом объеме получаемого питания, что представляет сложную задачу для врача [84,85]. Следует учитывать, что длительное применение некоторых медикаментов (стероидов и петлевых диуретиков) при ограниченном потреблении жидкости -это дополнительный фактор риска развития остеопении у детей с БЛД [86,87].…”

Management of Acute Kidney Injury in Extremely Low Birth Weight Infants

“…When hypernatremia (defined as serum sodium >150 umol/l) occurs, the causes is often inadequate free water administration, and may be associated with clinical evidence of volume depletion. Optimizing the fluid intake and free water will be the first step in management ( 98 – 101 ). When hypernatremia occurs without volume depletion in AKI, minimizing additional delivered sodium from red blood cell transfusion, albumin infusions, parenteral nutrition, carrier solutions for other medications, is especially important in first few days of life as increased IVH are seen in the context of early hypernatremia ( 102 ).…”