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Postoperative decrease in plasma sodium concentration after infusion of hypotonic intravenous solutions in neonatal

G Edjo Nkilly1, D Michelet, J Hilly

  • 1Department of Anaesthesia, Intensive Care and Pain Management.

British Journal of Anaesthesia
|November 7, 2013
PubMed
Summary
This summary is machine-generated.

Hypotonic intravenous solutions can lead to hyponatraemia in neonates undergoing surgery. Free water intake during surgery exceeding 6.5 ml kg(-1) h(-1) is linked to a significant drop in postoperative plasma sodium.

Keywords:
fluidshypotonici.v.neonatal surgeryneonatespostoperative hyponatraemia

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Area of Science:

  • Neonatal surgery
  • Pediatric anesthesiology
  • Intravenous fluid therapy

Background:

  • Hypotonic intravenous (i.v.) solutions are known to cause hyponatraemia in pediatric surgery.
  • This effect has not been previously established in neonatal surgical patients.
  • The study aimed to investigate the link between perioperative free water administration and plasma sodium levels in neonates.

Purpose of the Study:

  • To define the relationship between infused perioperative free water and plasma sodium in neonates undergoing surgery.
  • To identify a threshold of free water intake associated with significant reductions in plasma sodium.
  • To inform fluid management strategies in neonatal surgery.

Main Methods:

  • Prospective, observational study including newborns up to 7 days old undergoing abdominal or thoracic surgery.
  • Data collected: surgery type/duration, calculated i.v. free water intake, pre- and postoperative plasma sodium.
  • Statistical analyses included Pearson correlation, Mann-Whitney test, and ROC analysis with bootstrap.

Main Results:

  • Postoperative hyponatraemia occurred in 11.9% of 34 subjects.
  • A correlation was found between intraoperative free water intake and the change in plasma sodium (ΔNaP) (r=0.37, P=0.03).
  • Free water intake >6.5 ml kg(-1) h(-1) was associated with ΔNaP≥4 mM (Sensitivity 0.7, Specificity 0.5).

Conclusions:

  • Hypotonic i.v. fluids and high intraoperative free water intake (>6.5 ml kg(-1) h(-1)) are linked to reduced postoperative plasma sodium levels (≥4 mM).
  • Close monitoring of plasma sodium is essential during neonatal surgery.
  • Routine use of hypotonic i.v. solutions in neonates warrants reconsideration due to the risk of hyponatraemia.