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Late-Onset Hyponatremia in Premature Infants

Terri Marin1, Samuel H Dowell, Kristen Wright

  • 1Department of Nursing Science, Augusta University, College of Nursing, Augusta, Georgia (Dr Marin); and Departments of Pediatric Nephrology (Dr Mansuri) and Pediatrics, Division of Neonatology (Dr Mann), Medical College of Georgia, Augusta University (Mr Dowell and Ms Wright).

The Journal of Perinatal & Neonatal Nursing
|April 28, 2023
PubMed

Insights

Late-onset hyponatremia (LOH) in premature infants stems from poor sodium intake and kidney loss. Early recognition and proper sodium supplementation are crucial for preventing poor growth and developmental issues.

Area of Science:

  • Neonatalogy
  • Pediatric Nephrology

Background:

  • Late-onset hyponatremia (LOH) affects premature infants, characterized by low serum sodium levels.
  • It results from inadequate sodium intake and excessive renal sodium loss.
  • Untreated LOH can lead to significant complications, including impaired growth and neurodevelopmental delays.

Purpose of the Study:

  • To provide an overview of LOH pathophysiology.
  • To discuss the impact of LOH on infant development and related conditions.
  • To review management strategies and a novel sodium supplementation protocol.

Main Methods:

  • Review of existing literature on LOH.
  • Analysis of clinical definitions and diagnostic indicators, including spot urine sodium levels.
  • Description of current and proposed management protocols for sodium supplementation.

Main Results:

  • LOH is defined by specific serum sodium thresholds and can be indicated by low urinary sodium excretion.
  • Complications of LOH include poor somatic growth, neurodevelopmental delay, bronchopulmonary dysplasia, and retinopathy of prematurity.
  • Optimal serum sodium levels range from 135-145 mEq/L, but standardized supplementation protocols are lacking.

Conclusions:

  • LOH is a common issue in premature infants requiring careful monitoring and management.
  • Spot urine sodium levels may aid in identifying total body sodium deficits.
  • Effective sodium supplementation protocols are needed to prevent LOH and its adverse outcomes.

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