Vaginal Delivery and Low Gestational Age are Key Risk Factors for Hypernatremia in Neonates<32 Weeks

Abstract

Background Preterm neonates frequently experience hypernatremia (plasma sodium concentrations >145 mmol/l), which is associated with clinical complications, such as intraventricular hemorrhage.

Study design In this single center retrospective observational study, the following 7 risk factors for hypernatremia were analyzed in very low gestational age (VLGA, below 32 weeks) neonates: gestational age (GA), delivery mode (DM; vaginal or caesarian section), sex, birth weight, small for GA, multiple birth, and antenatal corticosteroids. Machine learning (ML) approaches were applied to obtain probabilities for hypernatremia.

Results 824 VLGA neonates were included (median GA 29.4 weeks, median birth weight 1170 g, caesarean section 83%). 38% of neonates experienced hypernatremia. Maximal sodium concentration of 144 mmol/l (interquartile range 142–147) was observed 52 hours (41–65) after birth. ML identified vaginal delivery and GA as key risk factors for hypernatremia. The risk of hypernatremia increased with lower GA from 22% for GA ≥ 31–32 weeks to 46% for GA < 31 weeks and 60% for GA < 27 weeks. A linear relationship between maximal sodium concentrations and GA was found, showing decreases of 0.29 mmol/l per increasing week GA in neonates with vaginal delivery and 0.49 mmol/l/week after cesarean section. Sex, multiple birth and antenatal corticosteroids were not associated hypernatremia.

Conclusion VLGA neonates with vaginal delivery and low GA have the highest risk for hypernatremia. Early identification of neonates at risk and early intervention may prevent extreme sodium excursions and associated clinical complications.

Zusammenfassung

Hintergrund Bei Frühgeborenen tritt häufig eine Hypernatriämie (Natrium im Plasma > 145 mmol/l) auf, welche mit klinischen Komplikationen wie Hirnblutungen assoziiert ist.

Patienten und MethodenDiese retrospektive Beobachtungsstudie untersuchte folgenden 7 Risikofaktoren für Hypernatriämie bei Neugeborenen mit sehr niedrigem Gestationsalter (VLGA, unter 32 Wochen): Gestationsalter (GA), Entbindungsmodus (DM) (vaginal oder Kaiserschnitt), Geschlecht, Geburtsgewicht, klein für GA, Mehrlingsgeburt und pränatale Lungenreife. Durch maschinelles Lernen (ML) wurden Risikofaktoren für Hypernatriämie analysiert.

Ergebnisse 824 VLGA-Neugeborene wurden eingeschlossen (GA Median 29,4 Wochen, Geburtsgewicht Median 1170 g, Kaiserschnitt 83%). 38% der Neugeborenen zeigten eine Hypernatriämie. Die maximale Natriumkonzentration von 144 mmol/l (Interquartilbereich 142–147) wurde 52 Stunden (41–65) nach der Geburt beobachtet. ML identifizierte vaginale Geburt und GA als Hauptrisikofaktoren für Hypernatriämie. Die Häufigkeit stieg mit niedrigerem GA von 22% für GA ≥31–32 Wochen auf 46% für GA <31 Wochen und 60% für GA <27 Wochen. Es bestand eine lineare Beziehung zwischen maximalem Natrium und GA (bei vaginaler Geburt Abnahme von 0,29mmol/l pro zunehmender Woche GA; bei Kaiserschnitt Abnahme von 0,49mmol/l pro Woche GA). Geschlecht, Mehrlingsgeburt und Lungenreife waren nicht mit erhöhtem Risiko einer Hypernatriämie assoziiert.

Schlussfolgerung VLGA-Neugeborene mit vaginaler Entbindung und niedrigem GA haben das höchste Risiko für Hypernatriämie. Frühes Identifizieren von Risikopatienten und frühe Intervention könnten extreme Natriumexkursionen und damit verbundene klinische Komplikationen verhindern.

Keywords

Preterm - Sodium - Hypernatremia - Risk factors

Schlüsselwörter

Frühgeborene - Natrium - Hypernatriämie - Risikofaktoren

Publication History

Article published online:
08 June 2021

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