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Sodium Values During the First 10 Postnatal Days in Extremely-Low-Birth-Weight Infants and Long-Term Neurocognitive
Sara Beyen1, Karel Allegaert1,2,3, Thomas Salaets4
1Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium.
Insights
Early sodium disturbances in extremely-low-birth-weight (ELBW) infants may increase the risk of severe brain bleeds and long-term neurodevelopmental issues. Further research is needed to confirm these associations and guide management.
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.
Purpose:
To synthesize all existing literature on the association between sodium disturbances during the first 10 days of life in Extremely-Low-Birth-Weight (ELBW) infants and the risk of developing severe intraventricular hemorrhage (IVH > grade 1) or long-term neurodevelopmental impairment.
Methods:
Applying systematic review (ID CDR42024622933) principles, five major databases were explored. Any study was included if it reported on ELBW infants, on serum sodium values within the first 10 postnatal days, or was related these to neurocognitive or neurodevelopmental outcomes.
Results:
Ten studies (13,276 infants) met inclusion criteria. Six studies evaluated the association between hypernatremia (>145 or >150 mmol/L) and severe IVH, and two reported a significant association. Among two studies studying hyponatremia (ranging <130 or <120 mmol/L), one found a significant association with severe IVH. Evidence regarding sodium fluctuations (difference between the maximum and minimum serum sodium values) identified fluctuations >13 mmol/L as a strong risk factor for severe IVH, while another study showed that glucose-corrected sodium fluctuations were independently associated with severe IVH. Long-term neurodevelopmental outcomes were reported in four studies; hyponatremia was significantly associated with hearing loss in one study (OR 5.6 (95% CI 1.1-27.8)), while another study reported that glucose-corrected sodium fluctuations were associated with neurodevelopmental impairment at 18-21 months, although significance disappeared after adjustment for confounding factors.
Conclusion:
Considering the limitations related to heterogeneity in study design, threshold sodium values and cohort size, this systematic review suggests a possible association between early sodium disturbances and adverse neurodevelopmental outcomes in ELBW infants, emphasizing the need for further high-quality, prospective studies, especially since sodium management can be modulated.
