Download PDF
Am J Perinatol 2018; 35(10): 994-1000
DOI: 10.1055/s-0038-1632366
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Physiological Approach to Sodium Supplementation in Preterm Infants

David E. Segar
1   Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
,
Elizabeth K. Segar
1   Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
,
Lyndsay A. Harshman
1   Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
,
John M. Dagle
1   Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
,
Susan J. Carlson
2   Department of Food and Nutritional Services, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
,
Jeffrey L. Segar
1   Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
› Author Affiliations
Further Information

Publication History

16 October 2017

12 January 2018

Publication Date:
27 February 2018 (online)

    Permissions and Reprints

Abstract

Objective To implement and evaluate a clinical practice algorithm to identify preterm infants with sodium deficiency and guide sodium supplementation based on urine sodium concentrations.

Study Design Urine sodium concentration was measured in infants born at 260/7 to 296/7 weeks' gestation at 2-week intervals. Sodium supplementation was based on the urine sodium algorithm. Growth and respiratory outcomes in this cohort were compared with a matched cohort cared for in our neonatal intensive care unit prior to algorithm implementation (2014–2015 cohort).

Results Data were compared for 50 infants in the 2014–2015 cohort and 40 infants in the 2016 cohort. Urine sodium concentration met criteria for supplementation in 75% of the 2016 cohort infants within the first 4 weeks after birth. Average daily sodium intake was greater in the 2016 cohort compared with the 2014–2015 cohort (p < 0.05). Caloric, protein, and total fluid intakes were similar between cohorts. The change in weight Z-score between 2 and 8 weeks of age was significantly greater in the 2016 versus 2014–2015 cohort (0.32 ± 0.05 vs. –0.01 ± 0.08; p < 0.01). No impact on respiratory status at 28 days of age or 36 weeks of postmenstrual age was identified.

Conclusion Institution of a clinical practice algorithm to instruct clinicians on sodium supplementation in preterm infants may improve growth outcomes.

Keywords

sodium - kidney - growth - premature infant - urine sodium
 

  • References

  • 1 Al-Dahhan J, Haycock GB, Chantler C, Stimmler L. Sodium homeostasis in term and preterm neonates. I. Renal aspects. Arch Dis Child 1983; 58 (05) 335-342
    CrossrefPubMedGoogle Scholar
  • 2 Gubhaju L, Sutherland MR, Horne RS. , et al. Assessment of renal functional maturation and injury in preterm neonates during the first month of life. Am J Physiol Renal Physiol 2014; 307 (02) F149-F158
    CrossrefPubMedGoogle Scholar
  • 3 Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Poole WK. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 2006; 117 (04) 1253-1261
    CrossrefPubMedGoogle Scholar
  • 4 Sammallahti S, Pyhälä R, Lahti M. , et al. Infant growth after preterm birth and neurocognitive abilities in young adulthood. J Pediatr 2014; 165 (06) 1109-1115
    CrossrefPubMedGoogle Scholar
  • 5 Franz AR, Pohlandt F, Bode H. , et al. Intrauterine, early neonatal, and postdischarge growth and neurodevelopmental outcome at 5.4 years in extremely preterm infants after intensive neonatal nutritional support. Pediatrics 2009; 123 (01) e101-e109
    CrossrefPubMedGoogle Scholar
  • 6 Ehrenkranz RA, Younes N, Lemons JA. , et al. Longitudinal growth of hospitalized very low birth weight infants. Pediatrics 1999; 104 (2 Pt 1): 280-289
    CrossrefPubMedGoogle Scholar
  • 7 Schrier RW. Diagnostic value of urinary sodium, chloride, urea, and flow. J Am Soc Nephrol 2011; 22 (09) 1610-1613
    CrossrefPubMedGoogle Scholar
  • 8 Vieux R, Hascoet JM, Merdariu D, Fresson J, Guillemin F. Glomerular filtration rate reference values in very preterm infants. Pediatrics 2010; 125 (05) e1186-e1192
    CrossrefPubMedGoogle Scholar
  • 9 Gallini F, Maggio L, Romagnoli C, Marrocco G, Tortorolo G. Progression of renal function in preterm neonates with gestational age < or = 32 weeks. Pediatr Nephrol 2000; 15 (1-2): 119-124
    CrossrefPubMedGoogle Scholar
  • 10 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59
    CrossrefPubMedGoogle Scholar
  • 11 Haycock GB, Schwartz GJ, Wisotsky DH. Geometric method for measuring body surface area: A height-weight formula validated in infants, children, and adults. J Pediatr 1978; 93 (01) 62-66
    CrossrefPubMedGoogle Scholar
  • 12 Vuohelainen T, Ojala R, Virtanen A. , et al. Decreased free water clearance is associated with worse respiratory outcomes in premature infants. PLoS One 2011; 6 (02) e16995
    CrossrefPubMedGoogle Scholar
  • 13 Vanpée M, Herin P, Broberger U, Aperia A. Sodium supplementation optimizes weight gain in preterm infants. Acta Paediatr 1995; 84 (11) 1312-1314
    CrossrefPubMedGoogle Scholar
  • 14 Hay Jr WW. Aggressive nutrition of the preterm infant. Curr Pediatr Rep 2013; 1 (04) 1
    CrossrefPubMedGoogle Scholar
  • 15 Griffin IJ, Tancredi DJ, Bertino E, Lee HC, Profit J. Postnatal growth failure in very low birthweight infants born between 2005 and 2012. Arch Dis Child Fetal Neonatal Ed 2016; 101 (01) F50-F55
    CrossrefPubMedGoogle Scholar
  • 16 Horbar JD, Ehrenkranz RA, Badger GJ. , et al. Weight growth velocity and postnatal growth failure in infants 501 to 1500 grams: 2000–2013. Pediatrics 2015; 136 (01) e84-e92
    CrossrefPubMedGoogle Scholar
  • 17 Fine BP, Ty A, Lestrange N, Levine OR. Sodium deprivation growth failure in the rat: alterations in tissue composition and fluid spaces. J Nutr 1987; 117 (09) 1623-1628
    CrossrefPubMedGoogle Scholar
  • 18 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 (12) 1279-1284
    CrossrefPubMedGoogle Scholar
  • 19 Wassner SJ. Altered growth and protein turnover in rats fed sodium-deficient diets. Pediatr Res 1989; 26 (06) 608-613
    CrossrefPubMedGoogle Scholar
  • 20 Mitchell HH, Carman GG. Does the addition of sodium chloride increase the value of a corn ration for growing animals?. J Biol Chem 1926; 68: 165-181
    PubMedGoogle Scholar
  • 21 Kleinman RE, Frank RG. , eds. Pediatric Nutrition: Policy of the American Academy of Pediatrics. 7th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2014
    Google Scholar
  • 22 Ziegler EE, O'Donnell AM, Nelson SE, Fomon SJ. Body composition of the reference fetus. Growth 1976; 40 (04) 329-341
    PubMedGoogle Scholar
  • 23 Delgado MM, Rohatgi R, Khan S, Holzman IR, Satlin LM. Sodium and potassium clearances by the maturing kidney: clinical-molecular correlates. Pediatr Nephrol 2003; 18 (08) 759-767
    CrossrefPubMedGoogle Scholar
  • 24 Isemann B, Mueller EW, Narendran V, Akinbi H. Impact of early sodium supplementation on hyponatremia and growth in premature infants: a randomized controlled trial. J Parenter Enteral Nutr 2016; 40 (03) 342-349
    CrossrefPubMedGoogle Scholar
  • 25 Edelman IS, Leibman J, O'Meara MP, Birkenfeld LW. Interrelations between serum sodium concentration, serum osmolarity and total exchangeable sodium, total exchangeable potassium and total body water. J Clin Invest 1958; 37 (09) 1236-1256
    CrossrefPubMedGoogle Scholar
  • 26 Nguyen MK, Kurtz I. Quantitative interrelationship between Gibbs-Donnan equilibrium, osmolality of body fluid compartments, and plasma water sodium concentration. J Appl Physiol (1985) 2006; 100 (04) 1293-1300
    CrossrefPubMedGoogle Scholar
  • 27 Butterworth SA, Lalari V, Dheensaw K. Evaluation of sodium deficit in infants undergoing intestinal surgery. J Pediatr Surg 2014; 49 (05) 736-740
    CrossrefPubMedGoogle Scholar
  • 28 Bischoff AR, Tomlinson C, Belik J. Sodium intake requirements for preterm neonates: review and recommendations. J Pediatr Gastroenterol Nutr 2016; 63 (06) e123-e129
    CrossrefPubMedGoogle Scholar