Neonatal Medicine

The Korean Society of Neonatology (대한신생아학회)
권호 표지
DOI QR코드

DOI QR Code

Association between Serum Hyponatremia and Severity of Respiratory Symptoms in Infants with Respiratory Syncytial Virus Infection

  • Yum, Sun Oh (Department of Pediatrics, Jeonbuk National University Hospital) ;
  • Kim, Hyun Ho (Department of Pediatrics, Jeonbuk National University Hospital) ;
  • Kim, Jin Kyu (Department of Pediatrics, Jeonbuk National University Hospital)
  • Received : 2020.04.03
  • Accepted : 2020.05.12
  • Published : 2020.05.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Association between hyponatremia and the severity of respiratory symptoms in infants with respiratory syncytial virus (RSV) infection has not yet been studied. This study aimed to compare respiratory symptoms, assessed using the Pediatric Respiratory Score (PRS), in infants with RSV infection, with or without hyponatremia. Methods: RSV-positive patients aged <12 months who were admitted with respiratory symptoms within 7 days of onset at Jeonbuk National University Children's Hospital from January 2016 to December 2019 were retrospectively analyzed. Each patient was categorized into those with or without hyponatremia (serum sodium concentration of <136 mmol/L). Clinical findings included PRS on the day of admission. Results: The mean±standard deviation age of the 125 patients included in the study was 2.7±3.3 months, and, 20 patients (16.0%) showed hyponatremia. Infants with RSV infection and hyponatremia had lower birth weights, longer hospital stays, and higher blood urea nitrogen level. The C-reactive protein level was significantly higher in the hyponatremic infants, who had higher PRSs. The non-hyponatremia group had more normal PRSs than the hyponatremia group, which had more severe PRSs. After adjustment for age at admission, blood urea nitrogen level (OR, 1.218; 95% CI, 1.023 to 1.451; P<0.05), and PRS grade (OR, 2.885; 95% CI, 1.158 to 7.187; P<0.05) were identified as independent risk factors. Conclusion: Hyponatremia was strongly associated with respiratory severity in infants with RSV. Therefore, infants admitted with RSV infection who show higher PRS grade need to be evaluated and treated for hyponatremia.

Keywords

References

  1. Eisenhut M. Extrapulmonary manifestations of severe respiratory syncytial virus infection: a systematic review. Crit Care 2006;10:R107. https://doi.org/10.1186/cc4984
  2. Hanna S, Tibby SM, Durward A, Murdoch IA. Incidence of hyponatraemia and hyponatraemic seizures in severe respiratory syncytial virus bronchiolitis. Acta Paediatr 2003;92:430-4. https://doi.org/10.1111/j.1651-2227.2003.tb00573.x
  3. Willson DF, Landrigan CP, Horn SD, Smout RJ. Complications in infants hospitalized for bronchiolitis or respiratory syncytial virus pneumonia. J Pediatr 2003;143(5 Suppl):S142-9.
  4. Park SW, Shin SM, Jeong M, Cho DH, Lee KH, Eisenhut M, et al. Hyponatremia in children with respiratory infections: a cross-sectional analysis of a cohort of 3938 patients. Sci Rep 2018;8:16494. https://doi.org/10.1038/s41598-018-34703-1
  5. Rutman L, Migita R, Spencer S, Kaplan R, Klein EJ. Standardized asthma admission criteria reduce length of stay in a pediatric emergency department. Acad Emerg Med 2016;23:289-96. https://doi.org/10.1111/acem.12890
  6. Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med 2000;342:1581-9. https://doi.org/10.1056/NEJM200005253422107
  7. Hoorn EJ, Zietse R. Diagnosis and treatment of hyponatremia: compilation of the guidelines. J Am Soc Nephrol 2017;28:1340-9. https://doi.org/10.1681/ASN.2016101139
  8. Seifert ME, Welak SR, Carroll CL. Hyponatremia is associated with increased severity of disease in critically ill children with bronchiolitis. Int J Clin Med 2010;1:37-40. https://doi.org/10.4236/ijcm.2010.12007
  9. Sockrider M, Katkin J. What is respiratory syncytial virus (RSV)? Am J Respir Crit Care Med 2015;191:P3-4. https://doi.org/10.1164/rccm.1913P3
  10. Kanai H, Sato Y, Ichihashi K. Hyponatremia in patients with respiratory syncytial virus bronchiolitis. Pediatric Health Med Ther 2012;3:39-43. https://doi.org/10.2147/PHMT.S33121
  11. McAdams RM, Hedstrom AB, DiBlasi RM, Mant JE, Nyonyintono J, Otai CD, et al. Implementation of bubble CPAP in a rural Ugandan neonatal ICU. Respir Care 2015;60:437-45. https://doi.org/10.4187/respcare.03438
  12. Rusmawati A, Haksari EL, Naning R. Downes score as a clinical assessment for hypoxemia in neonates with respiratory distress. Paediatr Indones 2008;48:342-5. https://doi.org/10.14238/pi48.6.2008.342-5
  13. Gozal D, Colin AA, Jaffe M, Hochberg Z. Water, electrolyte, and endocrine homeostasis in infants with bronchiolitis. Pediatr Res 1990;27:204-9. https://doi.org/10.1203/00006450-199002000-00023
  14. Szabo FK, Lomenick JP. Syndrome of inappropriate antidiuretic hormone secretion in an infant with respiratory syncytial virus bronchiolitis. Clin Pediatr (Phila) 2008;47:840-2. https://doi.org/10.1177/0009922808315222
  15. Rao M, Eid N, Mitchell M, Steiner P. Hyperinflation (airtrapping) as a stimulant of ADH response in children with chronic asthma. Pediatr Res 1985;19:413. https://doi.org/10.1203/00006450-198519040-00019
  16. Chaitra KM, Mohan Kumar N, Saipraneeth Reddy G. Hyponatremia in lower respiratory tract infections. Int J Contemp Pediatrics 2016;3:381-4.
  17. Picone S, Mondi V, Di Palma F, Martini L, Paolillo P. Neonatal encephalopathy and SIADH during RSV infection. Am J Perinatol 2019;36:S106-9. https://doi.org/10.1055/s-0039-1692132
  18. Kawashima H, Ioi H, Ushio M, Yamanaka G, Matsumoto S, Nakayama T. Cerebrospinal fluid analysis in children with seizures from respiratory syncytial virus infection. Scand J Infect Dis 2009;41:228-31. https://doi.org/10.1080/00365540802669543
  19. Kloiber LL, Winn NJ, Shaffer SG, Hassanein RS. Late hyponatremia in very-low-birth-weight infants: incidence and associated risk factors. J Am Diet Assoc 1996;96:880-4. https://doi.org/10.1016/S0002-8223(96)00240-4
  20. Sulyok E, Kovacs L, Lichardus B, Michajlovskij N, Lehotska V, Nemethova V, et al. Late hyponatremia in premature infants: role of aldosterone and arginine vasopressin. J Pediatr 1985;106:990-4. https://doi.org/10.1016/s0022-3476(85)80256-0
  21. Sahay M, Sahay R. Hyponatremia: a practical approach. Indian J Endocrinol Metab 2014;18:760-71. https://doi.org/10.4103/2230-8210.141320