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[Water and salt retention in low birth weight infants. Physiopathogenic discussion]
Insights
Salt and water retention (oedema) in low birth weight infants is linked to high-sodium cow's milk formulas. This condition, appearing around term age, can cause neurological issues but is treatable with frusemide.
Area of Science:
- Neonatal Medicine
- Pediatric Nephrology
- Perinatal Nutrition
Context:
- Observational study of 39 infants with salt and water retention.
- Focus on preterm or small for dates infants.
- Delayed onset of edema around 40 weeks corrected gestational age.
Purpose:
- Investigate the cause of salt and water retention in vulnerable infants.
- Determine the role of different milk formulas in edema development.
- Identify potential treatments for this iatrogenic condition.
Summary:
- High sodium content in non-modified cow's milk (21-25 mEq/L) is associated with frequent edema in low birth weight infants.
- Modified cow's milk (11 mEq/L) showed less frequent edema, while breast milk (7 mEq/L) showed none.
- Edema onset occurred around 40 weeks corrected gestational age, with neurological signs like intracranial hypertension appearing without treatment.
Impact:
- Highlights the iatrogenic nature of edema related to infant feeding practices.
- Suggests that formula sodium content is a critical factor in fluid balance for preterm infants.
- Demonstrates the efficacy of frusemide in resolving edema and preventing neurological complications.
Abstract:
Thirty-nine cases of salt and water retention have been observed in low birth weight infants, preterm or small for dates, during the past five years. The onset on the oedema was delayed and appeared on average at the age considered to be term, that is at about 40 weeks corrected gestational age. The iatrogenic nature of the oedema is shown by the evidence in the population at risk of preterm and small for dates infants: It is frequent when the milk is non-modified cow's milk which contains 21-25 mEq/1 of sodium, less common with modified cow's milk containing 11 mEq/sodium1 and and never with breast milk (7 mEq/1). In the absence of treatment neurological signs appeared, as showed by intracranial hypertension. One injection only of frusemide was often sufficient to interrupt the vicious circle.