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DOI: 10.1055/s-0034-1396691
Assessment of Association between Rapid Fluctuations in Serum Sodium and Intraventricular Hemorrhage in Hypernatremic Preterm Infants
Publication History
12 June 2014
23 October 2014
Publication Date:
29 December 2014 (online)
![](https://www.thieme-connect.de/media/ajp/201508/lookinside/thumbnails/10-1055-s-0034-1396691_140189-1.jpg)
Abstract
Aim This study aims to determine the association between the rapid fluctuations in serum sodium and intraventricular hemorrhage (IVH) or death in hypernatremic preterm infants.
Study Design Single center observational study including 216 infants < 1,000 g birth weight and <29 weeks gestational age, who had serum sodium levels monitored at least every 12 hours. Logistic regression analyses were used to identify which of the commonly cited risk factors for IVH, including the rapid (to the extent of ≥10 and ≥15 mmol/L/d) rise or fall in serum sodium, was associated with the primary outcome of any IVH, or the secondary composite outcome of severe IVH or death during the first 10 days of life in hypernatremic infants.
Results Of 216 infants, 126 (58%) studied developed hypernatremia (serum sodium ≥ 150 mmol/L). IVH was more frequent in hypernatremic infants (p = 0.01). Presence of hypernatremia was an independent risk factor for IVH on logistic regression analysis (p = 0.022, odds ratio 2.0, 95% confidence interval: 1.1–3.8). Rapid (≥ 10 and ≥ 15 mmol/L/d) rise or fall in serum sodium in hypernatremic infants was not associated with the outcomes.
Conclusion Hypernatremia per se, but not the rapid fluctuations (not exceeding 10–15 mmol/L/d) in serum sodium was independently associated with IVH.
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References
- 1 Sheth RD. Trends in incidence and severity of intraventricular hemorrhage. J Child Neurol 1998; 13 (6) 261-264
- 2 Wilson-Costello D, Friedman H, Minich N, Fanaroff AA, Hack M. Improved survival rates with increased neurodevelopmental disability for extremely low birth weight infants in the 1990s. Pediatrics 2005; 115 (4) 997-1003
- 3 Harkavy KL, Scanlon JW. Hypernatremia in the very low birthweight infant. Int J Pediatr Nephrol 1983; 4 (2) 75-78
- 4 Gawlowski Z, Aladangady N, Coen PG. Hypernatraemia in preterm infants born at less than 27 weeks gestation. J Paediatr Child Health 2006; 42 (12) 771-774
- 5 Geheb MA. Clinical approach to the hyperosmolar patient. Crit Care Clin 1987; 3 (4) 797-815
- 6 McManus ML, Churchwell KB, Strange K. Regulation of cell volume in health and disease. N Engl J Med 1995; 333 (19) 1260-1266
- 7 Cserr HF, DePasquale M, Patlak CS. Regulation of brain water and electrolytes during acute hyperosmolality in rats. Am J Physiol 1987; 253 (3 Pt 2) F522-F529
- 8 Adrogué HJ, Madias NE. Hypernatremia. N Engl J Med 2000; 342 (20) 1493-1499
- 9 Qureshi AI, Suri MF, Sung GY , et al. Prognostic significance of hypernatremia and hyponatremia among patients with aneurysmal subarachnoid hemorrhage. Neurosurgery 2002; 50 (4) 749-755 , discussion 755–756
- 10 Simmons MA, Adcock III EW, Bard H, Battaglia FC. Hypernatremia and intracranial hemorrhage in neonates. N Engl J Med 1974; 291 (1) 6-10
- 11 Larsen PD. Hypernatremic dehydration with hemorrhage into the choroid plexus. Pediatr Neurol 1989; 5 (2) 114-117
- 12 Laing IA, Wong CM. Hypernatraemia in the first few days: is the incidence rising?. Arch Dis Child Fetal Neonatal Ed 2002; 87 (3) F158-F162
- 13 Barnette AR, Myers BJ, Berg CS, Inder TE. Sodium intake and intraventricular hemorrhage in the preterm infant. Ann Neurol 2010; 67 (6) 817-823
- 14 Lim WH, Lien R, Chiang MC , et al. Hypernatremia and grade III/IV intraventricular hemorrhage among extremely low birth weight infants. J Perinatol 2011; 31 (3) 193-198
- 15 Bolat F, Oflaz MB, Güven AS , et al. What is the safe approach for neonatal hypernatremic dehydration? A retrospective study from a neonatal intensive care unit. Pediatr Emerg Care 2013; 29 (7) 808-813
- 16 Liamis G, Kalogirou M, Saugos V, Elisaf M. Therapeutic approach in patients with dysnatraemias. Nephrol Dial Transplant 2006; 21 (6) 1564-1569
- 17 Schwaderer AL, Schwartz GJ. Treating hypernatremic dehydration. Pediatr Rev 2005; 26 (4) 148-150
- 18 Volpe JJ. Brain injury in the premature infant: overview of clinical aspects, neuropathology, and pathogenesis. Semin Pediatr Neurol 1998; 5 (3) 135-151
- 19 Linder N, Haskin O, Levit O , et al. Risk factors for intraventricular hemorrhage in very low birth weight premature infants: a retrospective case-control study. Pediatrics 2003; 111 (5 Pt 1) e590-e595
- 20 Fabres J, Carlo WA, Phillips V, Howard G, Ambalavanan N. Both extremes of arterial carbon dioxide pressure and the magnitude of fluctuations in arterial carbon dioxide pressure are associated with severe intraventricular hemorrhage in preterm infants. Pediatrics 2007; 119 (2) 299-305
- 21 Kaiser JR, Gauss CH, Pont MM, Williams DK. Hypercapnia during the first 3 days of life is associated with severe intraventricular hemorrhage in very low birth weight infants. J Perinatol 2006; 26 (5) 279-285
- 22 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (4) 529-534
- 23 Shaffer SG, Meade VM. Sodium balance and extracellular volume regulation in very low birth weight infants. J Pediatr 1989; 115 (2) 285-290
- 24 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
- 25 Levene MI, Fawer CL, Lamont RF. Risk factors in the development of intraventricular haemorrhage in the preterm neonate. Arch Dis Child 1982; 57 (6) 410-417
- 26 Cooke RW. Factors associated with periventricular haemorrhage in very low birthweight infants. Arch Dis Child 1981; 56 (6) 425-431
- 27 Stoll BJ, Hansen NI, Bell EF , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126 (3) 443-456
- 28 Kasper DC, Mechtler TP, Böhm J , et al. In utero exposure to Ureaplasma spp. is associated with increased rate of bronchopulmonary dysplasia and intraventricular hemorrhage in preterm infants. J Perinat Med 2011; 39 (3) 331-336
- 29 Been JV, Degraeuwe PL, Kramer BW, Zimmermann LJ. Antenatal steroids and neonatal outcome after chorioamnionitis: a meta-analysis. BJOG 2011; 118 (2) 113-122