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The Changing Landscape of Sodium Needs in the Preterm Neonate for Optimizing Growth and Development
Chrysoula Kosmeri1, Maria Baltogianni2, Niki Dermitzaki2
1Department of Pediatrics, University Hospital of Ioannina, 45500 Ioannina, Greece.
Nutrients
|January 28, 2026
Summary
Preterm infants have immature kidneys, leading to significant sodium (Na) loss. Defining optimal sodium intake is crucial for their growth and development, yet current guidelines vary.
Area of Science:
- Neonatology
- Pediatric Nephrology
- Biochemistry
Background:
- Sodium (Na) is vital for fluid balance and rapid growth in neonates.
- Preterm infants experience significant renal sodium losses due to immature tubules.
- Existing data on sodium needs often comes from more mature infants, not the extremely preterm population.
Purpose of the Study:
- To review current evidence on sodium requirements in preterm infants.
- To clarify optimal sodium supplementation strategies for preterm neonates.
- To highlight knowledge gaps and the need for further research in this vulnerable population.
Main Methods:
- Narrative review of classic and contemporary scientific literature.
- Analysis of data on sodium balance and fractional excretion of sodium (FENa) in preterm infants.
- Comparison of current international guidelines for sodium supplementation.
Main Results:
- Preterm infants exhibit significant renal sodium losses, with immature tubules.
- Fractional excretion of sodium (FENa) inversely correlates with gestational and postnatal age.
- Current guidelines for sodium intake (e.g., ESPGHAN vs. AAP) show considerable variation.
Conclusions:
- Optimal sodium provision for preterm infants remains inadequately defined.
- Further research is needed to understand sodium metabolism in extremely preterm infants.
- Evidence-based supplementation strategies are crucial for improving preterm infant outcomes.
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