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. 2018 Aug;35(10):994-1000.
doi: 10.1055/s-0038-1632366. Epub 2018 Feb 27.

Physiological Approach to Sodium Supplementation in Preterm Infants

David E Segar  1 , Elizabeth K Segar  1 , Lyndsay A Harshman  1 , John M Dagle  1 , Susan J Carlson  2 , Jeffrey L Segar  1
Affiliations

Physiological Approach to Sodium Supplementation in Preterm Infants

David E Segar et al. Am J Perinatol. 2018 Aug.

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.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
(A) Estimated urine sodium concentration in infants 23 to 29 weeks of gestational age at postnatal ages of 2 to 8 weeks. Estimates based on the methodology outlined in text. (B) Estimated total urine sodium losses in infants 23 to 29 weeks of gestational age at postnatal ages of 2 to 8 weeks. Estimates based on the methodology outlined in text.
Fig. 2
Fig. 2
Serum sodium versus urine sodium concentrations measured at 2 weeks (A), 4 weeks (B), 6 weeks (C), and 8 weeks (D) of postnatal age in infants born at 260/7 to 296/7 weeks’ gestation.
Fig. 3
Fig. 3
Respiratory outcomes at 28 days of age for infants born at 260/7 to 29 6/7 weeks’ gestation in the 2014–2015 and 2016 cohorts. CPAP, continuous positive airway pressure; MV, mechanical ventilation; NC, nasal cannula; RA, room air.
See this image and copyright information in PMC

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