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Evaluation of sodium deficit in infants undergoing intestinal surgery
Sonia A Butterworth1, Vikki Lalari2, Keira Dheensaw3
1Children's Intestinal Rehabilitation Program, Division of Pediatric Surgery, University of British Columbia and British Columbia Children's Hospital, Vancouver, Canada.
Insights
Sodium depletion is common in pediatric patients after intestinal surgery, impacting growth. Achieving adequate urine sodium levels (>30 mmol/L) is linked to improved weight gain in these children.
Area of Science:
- Pediatric Surgery
- Pediatric Gastroenterology
- Neonatal Care
Background:
- Sodium is vital for pediatric growth; severe deficits impair development.
- Diagnosis and risks of sodium depletion in children undergoing intestinal surgery are not well understood.
Purpose of the Study:
- To investigate the prevalence and impact of sodium depletion in pediatric patients undergoing intestinal surgery.
- To determine the relationship between urine sodium levels and weight gain in this population.
Main Methods:
- Retrospective review of pediatric patients (2009-2012) who underwent intestinal surgery and had urine sodium measurements.
- Defined sodium deficits as urine sodium <30 mmol/L (deficient) and <10 mmol/L (severely deficient).
- Analyzed demographics, weight changes, intake, and correlated urine sodium with weight gain using regression and Mann Whitney U tests.
Main Results:
- 92% of 39 pediatric patients exhibited sodium deficiency, with 64% experiencing severe deficiency.
- Urine sodium levels significantly correlated with weight gain (p=0.002).
- Patients with urine sodium <30 mmol/L had significantly decreased weight gain (+0.58 g/d) compared to those with levels ≥30 mmol/L (+21.6 g/d).
Conclusions:
- Sodium depletion is highly prevalent in children undergoing intestinal surgery, irrespective of colon continuity.
- Correcting sodium deficits to achieve urine sodium >30 mmol/L is associated with improved weight gain in pediatric surgical patients.
Background:
Sodium is a critical growth factor for children. Severe deficits cause growth impairment and cognitive dysfunction. Both the diagnosis and risk of sodium depletion in children undergoing intestinal surgery are poorly understood.
Methods:
With IRB approval, children undergoing intestinal surgery (2009-2012) who had a urine sodium measurement were retrospectively reviewed. Sodium deficits were defined: urine sodium <30 mmol/L and <10 mmol/L were deficient and severely deficient, respectively. Demographics, weight changes, and intake (sodium, fluid, and nutritional) were tabulated. Data were analyzed using regression analysis and Mann Whitney U tests.
Results:
Thirty-nine patients, 51.3% female, with a gestational age of 32.2 weeks and weight of 1.43 kg were identified. The most common diagnoses were NEC (38.5%), intestinal atresia (20.5%), and isolated perforation (10.3%). Sodium deficiency was documented in 36/39 (92%) and 92.9% for those in continuity. Severe deficiency occurred in 64%. Urine sodium was significantly correlated with weight gain (p=0.002). Weight gain in patients with urine sodium <30 mmol/L was significantly decreased vs. those ≥30 mmol/L (+0.58 g/d vs. +21.6 g/d, p=0.016).
Conclusion:
In this population, sodium depletion is common in children undergoing intestinal surgery, even when the colon is in continuity. Correction of the sodium deficit to achieve urine sodium >30 mmol/L is associated with improved weight gain.
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