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Chloride Balance in Preterm Infants during the First Week of Life

Silvia Iacobelli1, Elsa Kermorvant-Duchemin, Francesco Bonsante

  • 1Neonatology and NICU, GHSR, CHR, BP 350, 97448 Saint Pierre Cedex, Réunion, France.

International Journal of Pediatrics
|April 17, 2012
PubMed

Insights

Chloride balance in preterm infants is linked to gestational age and sodium/chloride intake. High chloride levels correlate with metabolic acidosis but do not predict poor neurological outcomes.

Area of Science:

  • Neonatology
  • Pediatric Nephrology
  • Biochemistry

Background:

  • Infants born prematurely (25-32 weeks gestation) face unique hydroelectrolytic challenges.
  • Understanding chloride balance is crucial for managing fluid and electrolyte status in these vulnerable infants.

Purpose of the Study:

  • To characterize chloride balance in preterm infants.
  • To analyze associations between chloride changes, hydroelectrolytic status, and perinatal factors.
  • To investigate the relationship with neurological outcomes.

Main Methods:

  • Prospective determination of sodium and chloride balance, plasma electrolytes, and total carbon dioxide (tCO2) for 7 days post-birth.
  • Calculation of strong ion difference (SID).
  • Multivariate regression analyses to identify factors influencing chloride concentration, SID, and tCO2.

Main Results:

  • 107 preterm infants were studied.
  • Plasma chloride concentration positively correlated with plasma sodium concentration.
  • High plasma chloride and low SID were associated with lower plasma tCO2, indicating metabolic acidosis.
  • Chloride intake was the primary factor influencing high plasma chloride, low SID, and low tCO2, with sodium intake and lower gestational age also contributing.
  • Patent ductus arteriosus and birth weight loss independently affected plasma chloride and SID.
  • Neither high chloride levels nor low SID were linked to impaired neurological outcomes.

Conclusions:

  • Chloride balance in preterm infants is significantly influenced by gestational age and the interplay of sodium and chloride intake.
  • Elevated chloride levels are associated with metabolic acidosis in this population.
  • High chloride levels and low SID do not appear to increase the risk of adverse neurological outcomes.

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