Related Experiment Videos
Water, sodium and acid-base balance in premature infants: therapeutical aspects
Insights
Optimizing fluid therapy for premature infants (gestational age ≤ 34 weeks) involves maintaining stable sodium and acid-base balance. Higher sodium intake (4 mmol/kg/day) and sodium acetate showed promise in stabilizing plasma sodium and acid-base status.
Area of Science:
- Neonatology
- Pediatric Fluid and Electrolyte Management
- Perinatal Medicine
Background:
- Maintaining stable osmolality is crucial in premature infant fluid therapy.
- This involves balancing sodium, glucose, and acid-base levels.
- Premature infants (gestational age ≤ 34 weeks) are particularly vulnerable to fluid and electrolyte disturbances.
Purpose of the Study:
- To evaluate the impact of different sodium intake levels on fluid and electrolyte balance in premature infants.
- To assess the efficacy and practicality of using sodium acetate for acid-base balance.
- To establish guidelines for optimal fluid and electrolyte therapy in this population.
Main Methods:
- A randomized controlled trial involving 20 premature infants (gestational age ≤ 34 weeks).
- Two groups received different sodium intakes (2 mmol/kg/day vs. 4 mmol/kg/day) with varied sodium compounds.
- Fluid intake was restricted, and incubator humidity was high to minimize water loss.
Main Results:
- Weight loss was appropriate in both groups.
- A trend towards more stable plasma sodium concentration was observed in the higher sodium intake group.
- Sodium acetate effectively maintained normal acid-base balance, demonstrating practicality.
Conclusions:
- A protocol involving restricted fluid intake, high humidity, sodium supply of 3-4 mmol/kg/day, and sodium acetate for acidosis correction is recommended.
- This approach provides suitable guidelines for fluid and electrolyte therapy in premature infants ≤ 34 weeks' gestation.
- Higher sodium intake may contribute to better plasma sodium stability.
Abstract:
One of the main targets of fluid therapy in premature infants is to avoid variations in osmolality, which mainly means providing a stable sodium, glucose, and acid-base balance. Water, sodium, and acid-base balance were measured in 20 infants appropriate-for-gestational age with a gestational age less than or equal to 34 weeks. The infants were randomly assigned to one of two treatment groups. Fluid intake was restricted and air humidity in the incubator was high in order to minimize insensible water loss. Sodium intake in Group 1 was 2 mmol/kg/day and consisted of sodium chloride. Sodium intake in Group 2 was 4 mmol/kg/day and consisted of both sodium chloride and acetate. Weight loss was appropriate in both groups. In the high sodium intake group there was a tendency towards a more stable plasma sodium concentration than in the low sodium intake group. The use of sodium acetate was efficient and practical as normal acid-base balance was maintained. The protocol with restricted fluid intake (1st day 50 ml/kg, 2nd day 70 ml/kg, 3rd day 90 ml/kg, and 4th day 110 ml/kg), high air humidity, a sodium supply of 3 to 4 mmol/kg/day, and a slow correction of metabolic acidosis with sodium acetate, yields suitable guidelines in planning fluid and electrolyte therapy in premature infants less than or equal to 34 weeks' gestation.