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Published on: July 28, 2022
ELBW infants receive inadvertent sodium load above the recommended intake
Fabian Eibensteiner1, Gerda Laml-Wallner2, Margarita Thanhaeuser1
1Department of Paediatrics, Division of Neonatology, Paediatric Intensice Care and Neuropaediatrics, Medical University of Vienna, Vienna, Austria.
Insights
Extremely low birth weight infants receive excessive sodium, increasing risks for bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and mortality. Reducing inadvertent sodium intake is crucial for improving outcomes in these vulnerable newborns.
Area of Science:
- Neonatalogy
- Pediatric Nephrology
- Clinical Nutrition
Background:
- Extremely low birth weight (ELBW) infants often face significant fluid and electrolyte challenges.
- Assessing total sodium load, including inadvertent sources, is critical for optimizing care.
- Understanding sodium's impact on morbidity and mortality is essential for evidence-based neonatal practice.
Purpose of the Study:
- To quantify total sodium intake in ELBW infants during the first two postnatal weeks.
- To investigate the association between sodium load and serum sodium levels, morbidity, and mortality.
- To develop and evaluate models for sodium replacement in ELBW infants.
Main Methods:
- Retrospective analysis of data from ELBW infants with gestational age less than 28 weeks.
- Inclusion of 90 infants with a median birth weight of 718g and gestational age of 24.9 weeks.
- Calculation of sodium intake and correlation with clinical outcomes.
Main Results:
- Median sodium intake (10.2 mmol/kg/day) significantly exceeded recommendations (2-5 mmol/kg/day).
- Increased sodium intake correlated with higher risks of bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and mortality.
- No significant association found between sodium intake and hypernatremia risk.
Conclusions:
- ELBW infants experience excessive sodium loads, primarily from inadvertent sources, linked to increased morbidity and mortality.
- Alternative carrier solutions may reduce sodium intake, potentially improving infant outcomes.
- Further research is needed to establish causality and refine sodium management strategies.
Background:
To determine total sodium load, including inadvertent load, during the first 2 postnatal weeks, and its influence on serum sodium, morbidity, and mortality in extremely low birth weight (ELBW, birth weight <1000 g) infants and to calculate sodium replacement models.
Methods:
Retrospective data analysis on ELBW infants with a gestational age <28 + 0/7 weeks.
Results:
Ninety patients with a median birth weight of 718 g and a median gestational age of 24 + 6/7 weeks were included. Median sodium intake during the first 2 postnatal weeks was 10.2 mmol/kg/day, which was significantly higher than recommended (2-5 mmol/kg/day). Sodium intake did not affect the risk for hypernatremia. Each mmol of sodium intake during the first postnatal week was associated with an increased risk of bronchopulmonary dysplasia (45%) and higher-grade intraventricular hemorrhage (31%), during the second postnatal week for necrotizing enterocolitis (19%), and during both postnatal weeks of mortality (13%). Calculations of two sodium replacement models resulted in a decrease in sodium intake during the first postnatal week of 3.2 and 4.0 mmol/kg/day, respectively.
Conclusions:
Sodium load during the first 2 postnatal weeks of ELBW infants was significantly higher than recommended owing to inadvertent sodium intake and was associated with a higher risk of subsequent morbidity and mortality, although the study design does not allow conclusions on causality. Replacement of 0.9% saline with alternative carrier solutions might reduce sodium intake.
Impact:
Sodium intake in ELBW infants during the first 2 postnatal weeks was twofold to threefold higher than recommended; this was mainly caused by inadvertent sodium components. High sodium intake is not related to severe hypernatremia but might be associated with a higher morbidity in terms of BPD, IVH, and NEC. Inadvertent sodium load can be reduced by replacing high sodium-containing carrier solutions with high levels of sodium with alternative hypotonic and/or balanced fluids, model based.
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