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Risk factors for late-onset hyponatremia and its influence on neonatal outcomes in preterm infants
Yoon-Joo Kim1, Jin A Lee2, Sohee Oh3
1Department of Pediatrics, Jeju National University Hospital, Jeju, Korea.
Insights
Late-onset hyponatremia (LOH) affects 30% of preterm infants, linked to factors like prematurity and breast milk feeding. LOH increases risks for serious neonatal complications and prolonged hospital stays.
Area of Science:
- Neonatology
- Pediatric Nephrology
- Clinical Pediatrics
Background:
- Late-onset hyponatremia (LOH) is a common electrolyte imbalance in preterm infants after two weeks of age.
- It results from a negative sodium balance due to insufficient intake or excessive renal/intestinal losses.
- Immature organ function in preterm neonates predisposes them to LOH.
Purpose of the Study:
- To identify risk factors associated with LOH in preterm infants.
- To investigate the impact of LOH on neonatal outcomes.
- To understand the clinical significance of LOH in this vulnerable population.
Main Methods:
- Retrospective cohort analysis of 161 preterm infants (born <34 weeks gestation).
- Data collected between June 2009 and December 2010 at Seoul National University Hospital.
- LOH defined by serum sodium levels (≤132 mEq/L or 133-135 mEq/L with supplementation).
Main Results:
- LOH occurred in 30.4% of infants.
- Significant risk factors included lower gestational age, shorter parenteral nutrition, respiratory distress syndrome, furosemide use, and breast milk feeding.
- LOH was associated with longer hospital stays and increased risks of bronchopulmonary dysplasia and retinopathy of prematurity.
Conclusions:
- LOH is frequently observed in preterm infants.
- It may serve as a risk factor for significant morbidities like bronchopulmonary dysplasia and retinopathy of prematurity.
- LOH duration impacts the severity of outcomes, including BPD, PVL, and EUGR.
Abstract:
Late-onset hyponatremia (LOH), hyponatremia occurring after two weeks of age with the achievement of full feeding, is the result of a negative sodium balance caused by inadequate salt intake or excessive salt loss due to immature renal or intestinal function in preterm infants. The aims of our study were to identify the risk factors for LOH and its influence on neonatal outcomes. This was a retrospective cohort analysis of 161 preterm infants born before 34 weeks of gestation between June 2009 and December 2010 at Seoul National University Hospital. LOH was defined as a sodium level ≤ 132 mEq/L or 133-135 mEq/L with oral sodium supplementation. LOH occurred in 49 (30.4%) of the studied infants. A lower gestational age, a shorter duration of parenteral nutrition, the presence of respiratory distress syndrome, the use of furosemide, and feeding with breast milk were significant risk factors for LOH. In terms of neonatal outcomes, the infants with LOH had longer hospital stays and higher risks of bronchopulmonary dysplasia and retinopathy of prematurity requiring surgery. LOH lasting at least 7 days significantly increased moderate to severe bronchopulmonary dysplasia, periventricular leukomalacia, and extra-uterine growth retardation. LOH is commonly observed in preterm infants; it may be a risk factor for bronchopulmonary dysplasia and retinopathy of prematurity or a marker of illness severity.
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