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Higher versus lower sodium intake for preterm infants.

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Higher sodium intake in preterm infants may increase early hypernatraemia but reduce late hyponatraemia. More research is needed on long-term effects and other neonatal morbidities.

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Area of Science:

  • Neonatal Medicine
  • Pediatric Nephrology
  • Nutritional Science

Background:

  • Preterm infants face risks of early hypernatraemia and late hyponatraemia.
  • Sodium intake imbalances may affect neonatal health, growth, and development.

Approach:

  • Systematic review and meta-analysis of randomized controlled trials.
  • Compared higher versus lower sodium supplementation in preterm infants (<37 weeks gestation or <2500g birth weight).
  • Assessed outcomes including mortality, electrolyte imbalances, and growth, using GRADE certainty of evidence.

Key Points:

  • Early higher sodium intake may increase hypernatraemia risk (RR 1.62) but not affect hyponatraemia incidence.
  • Late higher sodium intake may reduce hyponatraemia incidence (RR 0.13) and potentially postnatal growth failure.
  • Evidence for effects on mortality, necrotising enterocolitis, and chronic lung disease remains uncertain due to low-certainty evidence.

Conclusions:

  • Early higher sodium supplementation may increase hypernatraemia risk in preterm infants.
  • Late higher sodium supplementation shows potential to reduce hyponatraemia and may improve growth.
  • Further research is required to clarify the long-term impacts and effects on other neonatal morbidities.