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A Swine Model of Neonatal Asphyxia
Published on: October 11, 2011
Randomised controlled trial of postnatal sodium supplementation on oxygen dependency and body weight in 25-30 week
G Hartnoll1, P Bétrémieux, N Modi
1Section of Paediatrics and Neonatal Medicine, Imperial College School of Medicine, Hammersmith Hospital, London W12 0NN.
Insights
Delaying sodium supplementation in preterm infants (25-30 weeks gestational age) until 6% birthweight loss is achieved may reduce oxygen dependency without impacting growth. This finding is crucial for optimizing care for vulnerable newborns.
Area of Science:
- Neonatalogy
- Pediatric critical care
- Perinatal medicine
Background:
- Preterm infants, particularly those between 25-30 weeks of gestational age, are at high risk for electrolyte imbalances and respiratory complications.
- Sodium supplementation is a common practice in neonatal care, but the optimal timing remains debated.
Purpose of the Study:
- To investigate the impact of early versus delayed sodium supplementation on oxygen dependency and body weight in preterm infants.
- To compare the clinical outcomes associated with different sodium supplementation strategies.
Main Methods:
- Randomized controlled trial involving preterm infants (25-30 weeks gestational age) stratified by gender and gestation.
- Infants were assigned to receive sodium supplementation on day 2 or after achieving 6% birthweight loss.
- Key parameters monitored included serum sodium, fluid and energy intake, oxygen requirement, and body weight at various postmenstrual ages.
Main Results:
- Delayed sodium supplementation was associated with a significantly lower risk of continuing oxygen requirement at the end of the first week and at 28 days.
- While the delayed group experienced greater maximum weight loss, there were no significant differences in growth parameters at 36 weeks or 6 months postmenstrual age.
- Early sodium supplementation and lower birthweight were significantly linked to a higher risk of prolonged oxygen dependency.
Conclusions:
- Delaying sodium supplementation until at least 6% of birthweight is lost offers a potential benefit in reducing the risk of ongoing oxygen requirements in preterm infants below 30 weeks gestation.
- This delayed approach does not appear to compromise infant growth and development.
- The findings suggest a revised strategy for sodium management in this vulnerable population.
Aim:
To compare the effects 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 differences in total fluid and energy intake between the two groups. There was a significant difference 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 (difference 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 (difference 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 differences 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 effect on the risk of continuing oxygen requirement and does not compromise growth.
