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Hypo- and Hypernatremia in Extremely Low Birth Weight Infants in the First 10 Days of Life: A Review
Myrna Pace1, Stijn van Sas1, Thomas Salaets2
1Faculty of Medicine, KU Leuven, 3000 Leuven, Belgium.
Insights
Sodium regulation in extremely low birth weight (ELBW) infants is complex, influenced by both care practices and infant maturity. Understanding these sodium dynamics is crucial for optimizing care in the first 10 days of life.
Area of Science:
- Neonatalogy
- Pediatric Nephrology
- Critical Care Medicine
Background:
- Sodium homeostasis is vital for extremely low birth weight (ELBW) infants.
- ELBW infants (<1000 g) present unique challenges in fluid and electrolyte management.
- Early postnatal sodium balance significantly impacts outcomes in vulnerable neonates.
Purpose of the Study:
- To comprehensively review sodium dynamics in ELBW infants during their first 10 postnatal days.
- To identify key variables influencing sodium levels in this population.
- To synthesize current evidence on sodium regulation in ELBW neonates.
Main Methods:
- Structured literature review adhering to PRISMA guidelines.
- Searched six databases for studies on sodium in ELBW cohorts.
- Included quality assessment of retained studies and data extraction.
Main Results:
- Eight heterogeneous studies were included (5 observational, 2 case-control, 1 RCT).
- Wide ranges in hypernatremia (8-92.2%) and hyponatremia (0-52.9%) incidence were reported.
- Serum sodium peaked on days 2-4, influenced by incubator settings, fluid regimens, skin care, and infant maturational factors (gestational age, postnatal age, SGA/AGA).
Conclusions:
- Documented patterns of sodium changes in ELBW infants over the first 10 days.
- Sodium levels are affected by care practices and infant's developmental stage.
- Highlights the need for standardized clinical practices, research definitions, and further data reporting.
Background/Objectives:
Sodium regulation is critical in extremely low birth weight (ELBW, <1000 g) infants. This study aimed to provide a comprehensive overview of sodium dynamics and related variables in ELBW infants in their first 10 days of life through a structured literature review.
Methods:
Applying PRISMA guidelines, six databases were searched (1 August 2023) on sodium measurements in ELBW cohorts, with quality assessment (RoB2, ROBINS-1, Newcastle Ottawa scale) of retained papers, and subsequent data extraction in line with these PRISMA guidelines to describe findings.
Results:
Only eight heterogeneous studies could be retained, including observational cohort studies (n = 5), case-control studies (n = 2, Tegaderm application yes/no, gestational age < 24 or 24-28 weeks), and only one randomized trial (sodium restriction versus no sodium restriction). Definitions of hyper- or hyponatremia were also heterogeneous, with incidence ranges for hyper- (8-92.2%) and hyponatremia (0-52.9%). Peak sodium values were observed on days 2-4 in the individual studies. When pooled and compared to the cohort mean sodium values, the highest increases in mean serum sodium values were observed on day 3 (+4, range, -0.6 to +8.6 mEq). Variables of sodium values were related to care factors [incubator settings (open/closed, double-/not double-walled, humidity), fluid regimens (water volume, sodium supplementation), occlusive skin care], as well as related maturational factors (postnatal age, gestational age, small versus appropriate for gestational age, SGA/AGA).
Conclusions:
Based on a structured literature review, patterns of sodium changes over postnatal age in ELBW cases were documented. Besides incubator settings, fluid regimens, or occlusive skin care, these patterns also depend on maturational factors of the ELBW infant (gestational age, postnatal age, SGA/AGA). These complexities emphasize the need for nuanced interpretation, the relevance of standardizing clinical practices and research definitions, and the need to report on additional datasets.
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