Sodium Values During the First 10 Postnatal Days in Extremely-Low-Birth-Weight Infants and Long-Term Neurocognitive...

Area of Science:

• Neonatal Medicine
• Neuroscience
• Pediatric Critical Care

Background:

• Extremely-low-birth-weight (ELBW) infants are vulnerable to electrolyte imbalances.
• Sodium disturbances are common in the neonatal period and can impact brain development.
• Severe intraventricular hemorrhage (IVH) and neurodevelopmental impairment are significant concerns in ELBW infants.

Purpose of the Study:

• To systematically review existing literature on the association between early-life sodium disturbances and adverse outcomes in ELBW infants.
• To investigate the link between serum sodium levels and severe IVH (grade > 1).
• To explore the relationship between sodium disturbances and long-term neurodevelopmental outcomes.

Main Methods:

• Systematic review of five major databases (ID CDR42024622933).
• Inclusion of studies reporting on ELBW infants, serum sodium values within the first 10 postnatal days, and neurodevelopmental outcomes.
• Analysis of ten studies involving 13,276 infants.

Main Results:

• Six studies found hypernatremia associated with severe IVH; two showed a significant link.
• One of two studies found hyponatremia associated with severe IVH.
• Sodium fluctuations (>13 mmol/L) were a strong risk factor for severe IVH; glucose-corrected fluctuations also showed association.
• Hyponatremia linked to hearing loss (OR 5.6); glucose-corrected fluctuations associated with neurodevelopmental impairment, though not always significant after adjustments.

Conclusions:

• Early sodium disturbances in ELBW infants may be associated with adverse neurodevelopmental outcomes.
• Limitations include heterogeneity in study design, sodium thresholds, and cohort sizes.
• High-quality, prospective studies are needed to confirm findings and inform clinical management, as sodium levels are modifiable.