Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Risk Factors and Effects of Severe Late-Onset Hyponatremia on Long-Term Growth of Prematurely Born Infants

  • Park, Ji Sook (Department of Pediatrics, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital) ;
  • Jeong, Seul-Ah (Department of Pediatrics, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital) ;
  • Cho, Jae Young (Department of Pediatrics, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital) ;
  • Seo, Ji-Hyun (Department of Pediatrics, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital) ;
  • Lim, Jae Young (Department of Pediatrics, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital) ;
  • Woo, Hyang Ok (Department of Pediatrics, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital) ;
  • Youn, Hee-Shang (Department of Pediatrics, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital) ;
  • Park, Chan-Hoo (Department of Pediatrics, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital)
  • Received : 2020.01.29
  • Accepted : 2020.05.16
  • Published : 2020.09.30
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Abstract

Purpose: Sodium is an essential nutritional electrolyte that affects growth. A low serum sodium concentration in healthy premature infants beyond 2 weeks of life is called late-onset hyponatremia (LOH). Here, we investigated the association between LOH severity and growth outcomes in premature infants. Methods: Medical records of premature infants born at ≤32 weeks of gestation were reviewed. LOH was defined as a serum sodium level <135 mEq/L regardless of sodium replacement after 14 days of life. Cases were divided into two groups, <130 mEq/L (severe) and ≥130 mEq/L (mild). Characteristics and growth parameters were compared between the two groups. Results: A total of 102 premature infants with LOH were included. Gestational age ([GA] 27.7 vs. 29.5 weeks, p<0.001) and birth weight (1.04 vs. 1.34 kg, p<0.001) were significantly lower in the severe group. GA was a risk factor of severe LOH (odds ratio [OR], 1.328, p=0.022), and severe LOH affected the development of bronchopulmonary dysplasia (OR, 2.950, p=0.039) and led to a poor developmental outcome (OR, 9.339, p=0.049). Growth parameters at birth were lower in the severe group, and a lower GA and sepsis negatively affected changes in growth for 3 years after adjustment for time. However, severe LOH was not related to growth changes in premature infants. Conclusion: Severe LOH influenced the development of bronchopulmonary dysplasia and developmental outcomes. However, LOH severity did not affect the growth of premature infants beyond the neonatal period.

Keywords

References

  1. Dell KM. Fluid, electrolytes, and acid-base homeostasis. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's neonatal-perinatal medicine: diseases of the fetus and infant. 10th ed. Philadelphia: Elsevier Saunders, 2015:613-29.
  2. Sulyok E. Renal aspects of sodium metabolism in the fetus and neonate. In: Oh W, Guignard JP, Baumgart S, eds. Nephrology and fluid/electrolyte physiology: neonatology questions and controversies. 2nd ed. Philadelphia: Elsevier Saunders, 2012:31-59.
  3. 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
  4. Kim YJ, Lee JA, Oh S, Choi CW, Kim EK, Kim HS, et al. Risk factors for late-onset hyponatremia and its influence on neonatal outcomes in preterm infants. J Korean Med Sci 2015;30:456-62. https://doi.org/10.3346/jkms.2015.30.4.456
  5. Gokce IK, Oguz SS. Late onset hyponatremia in preterm newborns: is the sodium content of human milk fortifier insufficient? J Matern Fetal Neonatal Med 2020;33:1197-202. https://doi.org/10.1080/14767058.2018.1517314
  6. Aviv A, Kobayashi T, Higashino H, Bauman JW Jr, Yu SS. Chronic sodium deficit in the immature rat: its effect on adaptation to sodium excess. Am J Physiol 1982;242:E241-7.
  7. Haycock GB. The influence of sodium on growth in infancy. Pediatr Nephrol 1993;7:871-5. https://doi.org/10.1007/BF01213376
  8. Isemann B, Mueller EW, Narendran V, Akinbi H. Impact of early sodium supplementation on hyponatremia and growth in premature infants: a randomized controlled trial. JPEN J Parenter Enteral Nutr 2016;40:342-9. https://doi.org/10.1177/0148607114558303
  9. Wassner SJ, Kulin HE. Diminished linear growth associated with chronic salt depletion. Clin Pediatr (Phila) 1990;29:719-21. https://doi.org/10.1177/000992289002901208
  10. Mansour F, Petersen D, De Coppi P, Eaton S. Effect of sodium deficiency on growth of surgical infants: a retrospective observational study. Pediatr Surg Int 2014;30:1279-84. https://doi.org/10.1007/s00383-014-3619-2
  11. Bischoff AR, Tomlinson C, Belik J. Sodium intake requirements for preterm neonates: review and recommendations. J Pediatr Gastroenterol Nutr 2016;63:e123-9. https://doi.org/10.1097/MPG.0000000000001294
  12. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978;187:1-7. https://doi.org/10.1097/00000658-197801000-00001
  13. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001;163:1723-9. https://doi.org/10.1164/ajrccm.163.7.2011060
  14. Fierson WM; American Academy of Pediatrics Section on Ophthalmology; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus; American Association of Certified Orthoptists. Screening examination of premature infants for retinopathy of prematurity. Pediatrics 2013;131:189-95. https://doi.org/10.1542/peds.2012-2996
  15. Kawai M. Late-onset circulatory collapse of prematurity. Pediatr Int 2017;59:391-6. https://doi.org/10.1111/ped.13242
  16. Wilkins BH. Renal function in sick very low birthweight infants: 3. Sodium, potassium, and water excretion. Arch Dis Child 1992;67:1154-61. https://doi.org/10.1136/adc.67.10_Spec_No.1154
  17. Kim H, Jung BM, Lee BN, Kim YJ, Jung JA, Chang N. Retinol, ${\alpha}$-tocopherol, and selected minerals in breast milk of lactating women with full-term infants in South Korea. Nutr Res Pract 2017;11:64-9. https://doi.org/10.4162/nrp.2017.11.1.64
  18. Yamawaki N, Yamada M, Kan-no T, Kojima T, Kaneko T, Yonekubo A. Macronutrient, mineral and trace element composition of breast milk from Japanese women. J Trace Elem Med Biol 2005;19:171-81. https://doi.org/10.1016/j.jtemb.2005.05.001

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