Urinary excretion of aldosterone, arginine vasopressin and Cortisol in premature infants with maximum renal acid stimulation

Kalhoff, Hermann; Rascher, Wolfgang; Diekmann, L; Stock, G. J.; Manz, Friedrich

doi:10.1111/j.1651-2227.1995.tb13680.x

Cited by 12 publications

(8 citation statements)

References 20 publications

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“…Previous research studies have demonstrated that infants with metabolic acidosis or maximum renal acid stimulation exhibit decreased growth [28,29]. This may also result in an increase in urinary sodium excretion [24,29] and a decrease in nitrogen assimilation [30]. Blood sampling for acid-base indicators may not be significantly abnormal in the presence of maximum renal acid excretion [22,28].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effect of Two Human Milk Fortifiers on Clinical Outcomes in Premature Infants

et al. 2014

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The use of human milk fortifiers (HMF) helps to meet the high nutritional requirements of the human milk-fed premature infant. Previously available powdered products have not met the protein requirements of the preterm infant population and many neonatologists add powder protein modulars to help meet protein needs. The use of powdered products is discouraged in neonatal intensive care units (NICU) due to concern for invasive infection. The use of a commercially available acidified liquid product with higher protein content was implemented to address these two concerns. During the course of this implementation, poor growth and clinically significant acidosis of infants on Acidified Liquid HMF (ALHMF) was observed. The purpose of this study was to quantify those observations by comparing infant outcomes between groups receiving the ALHMF vs. infants receiving powdered HMF (PHMF). A retrospective chart review compared outcomes of human milk-fed premature infants <2000 g receiving the ALHMF (n = 23) and the PHMF (n = 46). Infant growth, enteral feeding tolerance and provision, and incidence of necrotizing enterocolitis (NEC), metabolic acidosis, and diaper dermatitis were compared between the two groups. No infants were excluded from this study based on acuity. Use of ALHMF resulted in a higher incidence of metabolic acidosis (p = 0.002). Growth while on HMF as measured in both g/kg/day (10.59 vs. 15.37, p < 0.0001) and in g/day (23.66 vs. 31.27, p = 0.0001) was slower in the ALHMF group, on increased mean cal/kg/day (128.7 vs. 117.3, p = 0.13) with nearly twice as many infants on the ALHMF requiring increased fortification of enteral feedings beyond 24 cal/ounce to promote adequate growth (48% vs. 26%, p = 0.10). Although we were not powered to study NEC as a primary outcome, NEC was significantly increased in the ALHMF group. (13% vs. 0%, p = 0.03). Use of a LHMF in an unrestricted NICU population resulted in an increase in clinical complications within a high-acuity NICU, including metabolic acidosis and poor growth. Although further research is needed to assess outcomes among infants with a variety of clinical acuities, gestational ages, and weights to confirm these findings, based on this experience, caution is urged to avoid potential risks.

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Section: Discussionmentioning

confidence: 99%

Comparison of the Effect of Two Human Milk Fortifiers on Clinical Outcomes in Premature Infants

et al. 2014

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“…In patients with incipient late metabolic acidosis and no additional Na intake a low Na retention is not surprising. Moreover, premature infants with incipient late metabolic acidosis demonstrated increased urinary excretion rates of aldosterone whch were normalized by alkali therapy (20). As group B patients showed a more positive sodium balance than group C patients (perhaps due to pronounced alkalization).…”

Section: Group Bmentioning

confidence: 94%

Alkali therapy versus sodium chloride supplement in low birthweight infants with incipient late metabolic acidosis

et al. 1997

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Two hundred and eighty-two patients with birthweights below 2.0 kg were routinely screened for spontaneous development of maximum renal acid stimulation (urine-pH < 5.4). Sixty episodes in 53 patients of incipient late metabolic acidosis (urine pH < 5.4 on 2 consecutive days) were randomly allocated to oral therapy with 2 mmol/kg/day of either NaHCO3 or NaCl for 7 days. All 27 patients on NaHCO3 therapy, but only 15 from 26 patients on NaCl therapy, showed an increase in urine pH values, combined with a relatively high gain in body weight and a tendency to increased N-assimilation. Eleven patients on NaCl therapy showed persistent maximal renal acid stimulation on all 7 days with possibly lower weight gain and no clear change in N-assimilation. Thus, in patients with incipient late metabolic acidosis, NaCl therapy is not as beneficial as NaHCO3 therapy.

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“…The episodes usually occurred in the 2nd and 3rd weeks of life. Compared with controls, patients with incipient late metabolic acidosis showed a slightly lower blood pH (7.38 vs. 7.41) and base excess (-2.8 vs. 0.2 mmol/l) with respiratory compensation (PCO2 35 vs. 37 mmHg), higher serum creatinine values, and an increased urinary excretion of Na, aldosterone, and nitrogen [86]. Patients with episodes of late metabolic acidosis were subsequently randomly allocated to either treatment with NaHCO3 (2 mmol/kg per day) for 7 days or no therapy but regular clinical and biochemical controls in protocol I or NaHCO3 versus NaCl (2 mmol/kg per day each) in protocol II (Table 5).…”

Section: Late Metabolic Acidosismentioning

confidence: 95%

Renal acid excretion in early infancy

Manz

Kalhoff

Remer

1997

Pediatric Nephrology

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In early infancy, complex disorders of acid base metabolism are more frequent than in any other age group, with a predisposition to metabolic acidosis due to an age-related low renal capacity for acid excretion and an unphysiologically high actual renal acid load in nutrition with common formulas. Recently in preterm and small-for-gestational-age infants, persistent maximum renal net acid excretion (NAE) with subnormal or normal blood acid base status, impaired weight gain, and adaptive hormonal reactions have been observed. Incipient late metabolic acidosis is one example of a mixed disorder of acid base metabolism with maximum renal NAE in early infancy. Alkali therapy is highly effective and can be realized both on an individual basis, using urine pH screening as a diagnostic criterium for maximum renal acid stimulation, or on a general preventive level using modified standard formula with a reduced actual renal NAE similar to that seen on alimentation with human milk. From an integrated point of view, the low glomerular filtration rate and renal capacity for acid excretion beyond the developmental age of more than 44 weeks, may well be interpreted as the result of a specific adaptation to breast feeding sparing energy, and thus an evolutionary advantage for the survival of mother and child.

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Urinary excretion of aldosterone, arginine vasopressin and Cortisol in premature infants with maximum renal acid stimulation

Cited by 12 publications

References 20 publications

Comparison of the Effect of Two Human Milk Fortifiers on Clinical Outcomes in Premature Infants

Comparison of the Effect of Two Human Milk Fortifiers on Clinical Outcomes in Premature Infants

Alkali therapy versus sodium chloride supplement in low birthweight infants with incipient late metabolic acidosis

Renal acid excretion in early infancy

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