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Cord-Blood Derived Chemistry Reference Values in Preterm Infants for Sodium, Chloride, Potassium, Glucose, and CreatinineFunding A previous study on which this analysis is based received a grant for $24,933 from the Laboratory Services Health Services Research Funding Competition in 2002.
Objectives International guidelines recommend that preterm infants should be supported to maintain their serum electrolytes within “normal” ranges. In term babies, cord blood values differed in pathological pregnancies from healthy ones.
Study Design We examined cord blood sodium, chloride, potassium, glucose, and creatinine to derive maturity-related reference intervals. We examined associations with gestational age, delivery mode, singleton versus multiple, and prenatal maternal adverse conditions. We compared preterm cord values to term, and to adult reference ranges.
Results There were 591 infants, 537 preterm and 54 term. Preterm cord glucose levels were steady (3.7 ± 1.1 mmol/L), while sodium, chloride, and creatinine increased over GA by 0.17, 0.14 mmol/L/week, and 1.07 µmol/L/week, respectively (p < 0.003). Average preterm cord potassium and chloride were higher than the term (p < 0.05). Compared with adult reference intervals, cord preterm reference intervals were higher for chloride (100–111 vs. 98–106 mmol/L), lower for creatinine (29–84 vs. 62–115 µmol/L), and more variable for potassium (2.7–7.9 vs. 3.5–5.0 mmol/L) and sodium (130–141 vs. 136–145 mmol/L). Cesarean section was associated with higher potassium and lower glucose, multiple births with higher chloride and creatinine and lower glucose, and SGA with lower glucose.
Conclusions Cord blood values varied across the GA range with increases in sodium, chloride, and creatinine, while glucose remained steady. Average preterm reference values were higher than term values for potassium and chloride. Preterm reference values differed from published adults' reference values. The changes across GA and by delivery mode, SGA, and being a multiple, which may have direct implications for neonatal care and fluid management.
Cord blood electrolyte, creatinine, and glucose values vary across neonatal gestational age.
Average preterm cord values of potassium and chloride were higher than term values.
Cord reference values differ by delivery mode, growth, and multiple impacting neonatal care decisions.
Keywordscord blood - neonatal care - sodium - perinatal conditions - potassium - creatinine - chloride - glucose
None of the authors have any financial relationships relevant to this article to disclose.
Clinical Trial Registration
A.S. conceived the idea, developed the protocol, interpreted the data, wrote the first draft, reviewed edits, and approved the final version. R.I. contributed to the protocol, interpreted the data, critically reviewed and edited the manuscript, and approved the final version. M.S.R. analyzed the data, critically reviewed and edited the manuscript, and approved the final version. A.W.L. was part of the original research grant, edited the revision and addressed reviewers' comments. T.R. F. received the original grant to conduct the research, conceived the idea, developed the protocol, interpreted the data, reviewed edits, and approved the final version. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Received: 30 June 2021
Accepted: 20 December 2021
Accepted Manuscript online:
04 January 2022
Article published online:
07 February 2022
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- 1 Jochum F, Moltu SJ, Senterre T, Nomayo A, Goulet O, Iacobelli S. ESPGHAN/ESPEN/ESPR/CSPEN working group on pediatric parenteral nutrition. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: fluid and electrolytes. Clin Nutr 2018; 37 (6 Pt B): 2344-2353
- 2 Pediatric Nutrition, 8th Edition. Assessing nutrition Status. AAP Committee on Nutrition; Editors Ronald E. Kleinmann, MD, FAAP, and Frank R. Greer, MD, FAAP
- 3 Bischoff AR, Tomlinson C, Belik J. Sodium intake requirements for preterm neonates: review and recommendations. J Pediatr Gastroenterol Nutr 2016; 63 (06) e123-e129
- 4 Senterre T, Abu Zahirah I, Pieltain C, de Halleux V, Rigo J. Electrolyte and mineral homeostasis after optimizing early macronutrient intakes in VLBW infants on parenteral nutrition. J Pediatr Gastroenterol Nutr 2015; 61 (04) 491-498
- 5 Lorenz L, Peter A, Poets CF, Franz AR. A review of cord blood concentrations of iron status parameters to define reference ranges for preterm infants. Neonatology 2013; 104 (03) 194-202
- 6 Fenton TR, Lyon AW, Rose MS. Cord blood calcium, phosphate, magnesium, and alkaline phosphatase gestational age-specific reference intervals for preterm infants. BMC Pediatr 2011; 11: 76
- 7 Bossolan G, Trindade CE, Barreiros RC. Blood galactose and glucose levels in mothers, cord blood, and 48-hour-old breast-fed full-term infants. Neonatology 2007; 91 (02) 121-126
- 8 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13 (59) 59
- 9 Merck, Manual. Accessed April 14, 2021: https://www.merckmanuals.com/en-ca/professional/resources/normal-laboratory-values/blood-tests-normal-values
- 10 Ashoor I, De Jesús-González N, Somers M. Fluid and electrolyte physiology in the fetus and neonate. In: Chishti AS, Alam S, Kiessling SG. eds. Kidney and Urinary Tract Diseases in the Newborn. Berlin, Heidelberg: Springer; 2014: 77-98
- 11 Martinerie L, Pussard E, Foix-L'Hélias L. et al. Physiological partial aldosterone resistance in human newborns. Pediatr Res 2009; 66 (03) 323-328
- 12 Fijorek K, Püsküllüoğlu M, Tomaszewska D, Tomaszewski R, Glinka A, Polak S. Serum potassium, sodium and calcium levels in healthy individuals—literature review and data analysis. Folia Med Cracov 2014; 54 (01) 53-70
- 13 Aoki K, Akaba K. Characteristics of nonoliguric hyperkalemia in preterm infants: a case-control study in a single center. Pediatr Int (Roma) 2020; 62 (05) 576-580
- 14 Gruccio S, Di Carlo MB, Pandolfo M, Santa Cruz G, Touzon MS. et al. Biochemical Profiling Study in Umbilical Cord Blood as Predictors of Neonatal Damage. Int J Clin Pediatr 2014; 3 (01) 5-11
- 15 Bistritzer T, Berkovitch M, Rappoport MJ. et al. Sodium potassium adenosine triphosphatase activity in preterm and term infants and its possible role in sodium homeostasis during maturation. Arch Dis Child Fetal Neonatal Ed 1999; 81 (03) F184-F187
- 16 Russell JM. Sodium-potassium-chloride cotransport. Physiol Rev 2000; 80 (01) 211-276
- 17 Sulemanji M, Vakili K. Neonatal renal physiology. Semin Pediatr Surg 2013; 22 (04) 195-198
- 18 Perkins SL, Livesey JF, Belcher J. Reference intervals for 21 clinical chemistry analytes in arterial and venous umbilical cord blood. Clin Chem 1993; 39 (06) 1041-1044
- 19 Acharya PT, Payne WW. Blood chemistry of normal full-term infants in the first 48 hours of life. Arch Dis Child 1965; 40: 430-435
- 20 Guignard JP, Drukker A. Why do newborn infants have a high plasma creatinine?. Pediatrics 1999; 103 (04) e49
- 21 Yunos NM, Bellomo R, Story D, Kellum J. Bench-to-bedside review: chloride in critical illness. Crit Care 2010; 14 (04) 226
- 22 Hinchliffe SA, Lynch MR, Sargent PH, Howard CV, Van Velzen D. The effect of intrauterine growth retardation on the development of renal nephrons. Br J Obstet Gynaecol 1992; 99 (04) 296-301
- 23 Stritzke A, Thomas S, Amin H, Fusch C, Lodha A. Renal consequences of preterm birth. Mol Cell Pediatr 2017; 4 (01) 2
- 24 Narvey MR, Marks SD. The screening and management of newborns at risk for low blood glucose. Paediatr Child Health 2019; 24 (08) 536-554
- 25 Narai S, Kawashima-Sonoyama Y, Fujimoto M. et al. Cord blood from SGA preterm infants exhibits increased GLUT4 mRNA expression. Yonago Acta Med 2021; 64 (01) 57-66
- 26 Sahasrabuddhe A, Pitale S, Raje D, Sagdeo MM. Cord blood levels of insulin and glucose in full-term pregnancies. J Assoc Physicians India 2013; 61 (06) 378-382