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Hyperkalemia during the early postnatal days in premature infants
Han-Chih Yuan1, Mei-Jy Jeng, Wen-Jue Soong
1Department of Pediatrics, Children's Medical Center, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Insights
Hyperkalemia, or high potassium, is common in extremely premature infants during their first 48 hours. This condition is linked to smaller gestational age, lower birth weight, and more severe respiratory distress syndrome.
Area of Science:
- Neonatal Medicine
- Pediatric Nephrology
- Clinical Chemistry
Background:
- Plasma electrolyte concentrations are often unstable in premature infants.
- Hyperkalemia can lead to severe, life-threatening symptoms in neonates.
Purpose of the Study:
- To analyze the incidence and clinical characteristics of hyperkalemia in premature infants.
- To identify risk factors and associated conditions of hyperkalemia in this population.
Main Methods:
- Retrospective review of medical records for 95 premature infants.
- Analysis of plasma electrolytes, blood urea nitrogen, creatinine, blood pH, and urine output within the first 96 hours of life.
- Exclusion of infants with major congenital anomalies or early mortality.
Main Results:
- Plasma potassium showed negative correlations with gestational age and birth weight.
- Infants with gestational age < 29 weeks had significantly higher potassium levels.
- 44% of infants experienced peak plasma potassium ≥ 6 mEq/L; hyperkalemic infants were more likely to be female, have severe respiratory distress syndrome (RDS), and require inotropics.
Conclusions:
- Hyperkalemia is a frequent issue in extremely premature infants within the first two days of life.
- Factors associated with hyperkalemia include small gestational age, very low birth weight, female gender, severe RDS, need for surfactant/inotropics, delayed feeding, and higher mortality.
Abstract:
Plasma electrolyte concentrations in premature infants are unstable, and hyperkalemia may induce significant, even life-threatening, symptoms in tiny infants. The medical records of 95 premature infants were retrospectively reviewed. Patients with a major congenital anomaly or mortality within 24 h after birth were excluded. Plasma electrolytes, blood urea nitrogen, creatinine, blood pH, urine output, and related clinical conditions during first 96 h of life were analyzed. Plasma potassium concentrations had significant negative correlations with gestational age and birth weight (p < 0.05). Infants with a gestational age of less than 29 weeks had significantly higher potassium concentrations (average 5.9 +/- 0.3 mEq/L, peak 7.8 +/- 0.4 mEq/L, p < 0.05) than other gestational age groups, and their plasma potassium levels were significantly higher at 24 and 48 h of age (p < 0.05). Forty-two infants (42/95, 44%) had peak plasma potassium concentrations greater than or equal to 6 mEq/L. With statistical analysis, the hyperkalemic infants comprised of significantly (p < 0.05) fewer males (31% vs. 55%), they had more-severe respiratory distress syndrome (RDS) (grades 2 +/- 0 vs. 1 +/- 0, p < 0.05), and needed more frequent use of inotropics (52% vs. 23%, p < 0.05) compared to normokalemic infants. In conclusion, hyperkalemia during the first 2 days of life is common in extremely premature infants. Small gestational age, very low birth weight, female gender, high RDS grade, need of exogenous surfactant and inotropic agents, delayed feeding, and a high mortality rate were observed in hyperkalemic infants.