Download PDF
Am J Perinatol 2024; 41(06): 722-729
DOI: 10.1055/a-1730-8536
Original Article

Cord-Blood Derived Chemistry Reference Values in Preterm Infants for Sodium, Chloride, Potassium, Glucose, and Creatinine

Amelie Stritzke 
1   Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
2   Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
3   Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
,
Rana Ismail
1   Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
,
M. Sarah Rose
4   Research Excellence Support Team, Alberta Health Services, Calgary, Calgary, Canada
,
Andrew W. Lyon
5   Pathology and Laboratory Medicine, Saint Pauls Hospital Laboratory, Saskatoon, Saskatchewan, Canada
,
Tanis R. Fenton
3   Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
6   Community Health Sciences, University of Calgary, Calgary, Canada
7   Nutrition Services, Alberta Health Services, Calgary, Canada
› Author Affiliations Funding 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.
› Further Information
    Permissions and Reprints

Abstract

Objective 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.

Conclusion 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.

Key Points

  • 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.

Keywords

cord blood - neonatal care - sodium - perinatal conditions - potassium - creatinine - chloride - glucose

Authors' Contribution

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.




Publication History

Received: 30 June 2021

Accepted: 20 December 2021

Accepted Manuscript online:
04 January 2022

Article published online:
07 February 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 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
    Google Scholar
  • 2 Pediatric Nutrition, 8th Edition. Assessing nutrition Status. AAP Committee on Nutrition; Editors Ronald E. Kleinmann, MD, FAAP, and Frank R. Greer, MD, FAAP
    Google Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 9 Merck, Manual. Accessed April 14, 2021 at: https://www.merckmanuals.com/en-ca/professional/resources/normal-laboratory-values/blood-tests-normal-values
    Google Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 16 Russell JM. Sodium-potassium-chloride cotransport. Physiol Rev 2000; 80 (01) 211-276
    Google Scholar
  • 17 Sulemanji M, Vakili K. Neonatal renal physiology. Semin Pediatr Surg 2013; 22 (04) 195-198
    Google Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 20 Guignard JP, Drukker A. Why do newborn infants have a high plasma creatinine?. Pediatrics 1999; 103 (04) e49
    Google Scholar
  • 21 Yunos NM, Bellomo R, Story D, Kellum J. Bench-to-bedside review: chloride in critical illness. Crit Care 2010; 14 (04) 226
    Google Scholar
  • 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
    Google Scholar
  • 23 Stritzke A, Thomas S, Amin H, Fusch C, Lodha A. Renal consequences of preterm birth. Mol Cell Pediatr 2017; 4 (01) 2
    Google Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar