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Effect of early sodium supplementation on weight gain of very preterm infants: a randomised controlled trial
Anvesh Amiti1, Umamaheswari Balakrishnan1, Usha Devi1,2
1Neonatology, Sri Ramachandra Medical College and Research Institute, Chennai, India.
Insights
Early enteral sodium supplementation significantly improved weight gain and linear growth in preterm neonates. This intervention helps combat growth failure in premature infants due to renal immaturity.
Area of Science:
- Neonatal Medicine
- Pediatric Nutrition
- Growth and Development
Background:
- Preterm neonates face impaired growth risks.
- Hyponatraemia in preterm infants stems from renal immaturity, potentially causing growth failure.
- Early postnatal sodium is crucial for neonatal growth.
Purpose of the Study:
- To evaluate the impact of early enteral sodium supplementation on weight gain velocity in preterm neonates.
- To assess growth from birth to 34 weeks postmenstrual age.
- To determine if sodium supplementation mitigates hyponatraemia-related growth failure.
Main Methods:
- Double-blinded, randomized controlled trial involving neonates born between 25 and 30 weeks+6 days gestation.
- Intervention group received 4 mEq/kg/day oral sodium; control group received placebo.
- Primary outcome: mean weight gain velocity (g/kg/day) up to 34 weeks postmenstrual age.
Main Results:
- Significantly greater weight gain velocity in the sodium supplementation group (18.0±4.4 g/kg/day) versus placebo (14.4±3.9 g/kg/day).
- Improved linear growth (0.88±0.18 cm/week) in the intervention group compared to controls (0.73±0.28 cm/week).
- No significant differences in head growth or clinical outcomes observed.
Conclusions:
- Early postnatal sodium supplementation enhances in-hospital weight gain in very preterm neonates.
- This supplementation also promotes linear growth in this vulnerable population.
- Findings suggest sodium supplementation is a viable strategy to improve growth outcomes in preterm infants.
Background And Objectives:
Preterm neonates are at risk of impaired growth. Hyponatraemia in preterm neonates is due to renal immaturity and can lead to growth failure. We aimed to assess the effect of early enteral sodium supplementation on weight gain velocity from birth to 34 weeks postmenstrual age in preterm neonates.
Methods:
In this double-blinded randomised controlled trial, we recruited neonates born between 25 weeks and 30 weeks+6 days of gestation who received a minimum feed volume of 100 mL/kg/day before 10 days of life. In the intervention group, 4 mEq/kg/day of oral sodium was administered using 15% saline and, in the control group, normal saline was given as a placebo. The primary outcome was mean weight gain velocity in g/kg/day.
Results:
A total of 104 neonates were recruited with 52 infants in each group. Mean (SD) weight gain velocity (g/kg/day) was significantly greater in intervention than in control group (18.0±4.4 vs 14.4±3.9; mean difference 3.6 with 95% CI 2.04 to 5.27, p<0.001). Linear growth (cm/week) was greater in intervention than in control group (0.88±0.18 vs 0.73±0.28 cm/week; mean difference 0.14 with 95% CI 0.05 to 0.24, p=0.04). Subgroup analysis in extreme preterm showed similar results. There was no significant difference in head growth or clinical outcomes between the groups.
Conclusion:
Early postnatal sodium supplementation improves in-hospital weight gain and linear growth in very preterm neonates.
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