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Somatic growth outcomes in response to an individualized neonatal sodium supplementation protocol
Elliot J Stalter1, Silvia L Verhofste1, John M Dagle1
1Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa, IA, USA.
Insights
Protocolized sodium (Na) supplementation improved growth and reduced mechanical ventilation time in extremely preterm infants. This approach did not increase the incidence of common morbidities in this vulnerable population.
Area of Science:
- Neonatal Medicine
- Pediatric Nutrition
- Critical Care Pediatrics
Background:
- Optimizing sodium (Na) balance is crucial for preterm infants.
- Current supplementation protocols lack standardization, particularly regarding urine Na monitoring.
- Effective Na management impacts growth and clinical outcomes in extremely preterm neonates.
Purpose of the Study:
- To evaluate the impact of a novel Na supplementation protocol guided by urine Na concentration.
- To assess effects on growth parameters and incidence of morbidities in preterm infants.
Main Methods:
- Retrospective cohort study comparing infants before (2012-15) and after (2016-20) protocol implementation.
- Included infants 260/7-336/7 weeks gestational age (GA).
- Analyzed growth (weight, head circumference) and morbidities using generalized linear models.
Main Results:
- For infants 260/7-296/7 weeks GA, the protocol improved body weight and head circumference z-scores.
- Associated with decreased duration of mechanical ventilation in the same subgroup.
- No significant impact on growth for infants 30-336/7 weeks GA; no increase in hypertension, hypernatremia, BPD, NEC, or sepsis.
Conclusions:
- Protocolized Na supplementation positively influences growth and reduces mechanical ventilation needs in extremely preterm infants.
- This evidence-based approach appears safe, not elevating risks for major neonatal morbidities.
Objective:
Evaluate the impact of a sodium (Na) supplementation protocol based upon urine Na concentration on growth parameters and morbidities.
Study Design:
Retrospective cohort study of infants 260/7-336/7 weeks gestational age (GA) cared for before (2012-15, n = 310) and after (2016-20, n = 382) implementation of the protocol. Within- and between-group changes over time were assessed using repeated measures generalized linear models.
Results:
For infants 260/7-296/7 weeks GA, utilization of the protocol was associated with increased mean body weight z-score at 8-weeks postnatal age, increased mean head circumference z-score at 16-weeks postnatal age, and decreased time on mechanical ventilation (all p < 0.02). No impact on growth was identified for infants 30-336/7 weeks GA. Incidences of hypertension, hypernatremia, bronchopulmonary dysplasia, necrotizing enterocolitis, and culture positive sepsis were unaffected by the protocol.
Conclusion:
Protocolized Na supplementation is associated with improved growth and reduced time on invasive mechanical ventilation in extremely preterm infants without increasing incidence of morbidities.
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