Yonsei Med J.  2013 May;54(3):696-701. 10.3349/ymj.2013.54.3.696.

Non-Oliguric Hyperkalemia in Extremely Low Birth Weight Infants

• Kwak JR
• Gwon M
• Lee JH
• Park MS
• Kim SH

• KMID: 1727885
• DOI: http://doi.org/10.3349/ymj.2013.54.3.696

Abstract

PURPOSE
It is to examine clinical manifestations, early biochemical indicators, and risk factors for non-oliguric hyperkalemia (NOHK) in extremely low birth weight infants (ELBWI).
MATERIALS AND METHODS
We collected clinical and biochemical data from 75 ELBWI admitted to Ajou University Hospital between Jan. 2008 and Jun. 2011 by reviewing medical records retrospectively. NOHK was defined as serum potassium > or =7 mmol/L during the first 72 hours of life with urine output > or =1 mL/kg/h.
RESULTS
NOHK developed in 26.7% (20/75) of ELBWI. Among NOHK developed in ELBWI, 85% (17/20) developed within postnatal (PN) 48 hours, 5% (1/20) experienced cardiac arrhythmia and 20% (4/20) of NOHK infants expired within PN 72 hours. There were statistically significant differences in gestational age, use of antenatal steroid, and serum phosphorous level at PN 24 hours, and serum sodium, calcium, and urea levels at PN 72 hours between NOHK and non-NOHK groups (p-value <0.050). However, there were no statistical differences in the rate of intraventricular hemorrhage, arrhythmia, mortality occurred, methods of fluid therapy, supplementation of amino acid and calcium, frequencies of umbilical artery catheterization and urine output between the two groups.
CONCLUSION
NOHK is not a rare complication in ELBWI. It occurs more frequently in ELBWI with younger gestational age and who didn't use antenatal steroid. Furthermore, electrolyte imbalance such as hypernatremia, hypocalcemia and hyperphosphatemia occurred more often in NOHK group within PN 72 hours. Therefore, more use of antenatal steroid and careful control by monitoring electrolyte imbalance should be considered in order to prevent NOHK in ELBWI.

Keyword

Infant; extremely low birth weight; hyperkalemia; infants; premature

MeSH Terms

Gestational Age
Humans
Hyperkalemia/diagnosis/drug therapy/*epidemiology
*Infant, Extremely Low Birth Weight
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases/diagnosis/drug therapy/*epidemiology
Republic of Korea
Risk Factors

Reference

1. Apitz C, Wirbelauer J. [Circulatory failure due to severe cardiac arrhythmia as a result of hyperkalemia in a very low birth weight infant]. Klin Padiatr. 2006. 218:16–19.

2. Gruskay J, Costarino AT, Polin RA, Baumgart S. Nonoliguric hyperkalemia in the premature infant weighing less than 1000 grams. J Pediatr. 1988. 113:381–386.

3. Vemgal P, Ohlsson A. Interventions for non-oliguric hyperkalaemia in preterm neonates. Cochrane Database Syst Rev. 2007. CD005257.

4. Yuan HC, Jeng MJ, Soong WJ, Chen SJ, Hwang BT. Hyperkalemia during the early postnatal days in premature infants. Acta Paediatr Taiwan. 2003. 44:208–214.

5. Shortland D, Trounce JQ, Levene MI. Hyperkalaemia, cardiac arrhythmias, and cerebral lesions in high risk neonates. Arch Dis Child. 1987. 62:1139–1143.

6. Fiona M, O'Hare EJM. Clinical pattern recognition in the diagnosis of severe hyperkalemia in preterm infant. 2007. In : Pediatric Academic Society Meeting; Toronto.

7. Singh D, Dutta S, Narang A. Hyperkalemia and ventricular tachycardia in ELBW infant. Indian Pediatr. 2003. 40:64–66.

8. Wren C. Hyperkalaemia, cardiac arrhythmias, and cerebral lesions in high risk neonates. Arch Dis Child. 1988. 63:681–682.

9. Mildenberger E, Versmold H. [Results of a National Survey in Germany on incidence and therapy of the nonoliguric hyperkalemia of the premature infant]. Z Geburtshilfe Neonatol. 2002. 206:9–14.

10. Usher R. The respiratory distress syndrome of prematurity. I. Changes in potassium in the serum and the electrocardiogram and effects of therapy. Pediatrics. 1959. 24:562–576.

11. Leslie GI, Carman G, Arnold JD. Early neonatal hyperkalaemia in the extremely premature newborn infant. J Paediatr Child Health. 1990. 26:58–61.

12. Brion LP, Schwartz GJ, Campbell D, Fleischman AR. Early hyperkalaemia in very low birthweight infants in the absence of oliguria. Arch Dis Child. 1989. 64:270–272.

13. Mildenberger E, Versmold HT. Pathogenesis and therapy of non-oliguric hyperkalaemia of the premature infant. Eur J Pediatr. 2002. 161:415–422.

14. Lorenz JM, Kleinman LI, Markarian K. Potassium metabolism in extremely low birth weight infants in the first week of life. J Pediatr. 1997. 131(1 Pt 1):81–86.

15. Stefano JL, Norman ME, Morales MC, Goplerud JM, Mishra OP, Delivoria-Papadopoulos M. Decreased erythrocyte Na+,K(+)-ATPase activity associated with cellular potassium loss in extremely low birth weight infants with nonoliguric hyperkalemia. J Pediatr. 1993. 122:276–284.

16. Sato K, Kondo T, Iwao H, Honda S, Ueda K. Internal potassium shift in premature infants: cause of nonoliguric hyperkalemia. J Pediatr. 1995. 126:109–113.

17. Shim JW, Ko SY, Kim SS, Kim MJ, Chang YS, Park WS. Non-oliguric hyperkalemia in extremely low birth weight infants. J Korean Soc Neonatol. 2002. 9:21–28.

18. Yaseen H. Nonoliguric hyperkalemia in neonates: a case-controlled study. Am J Perinatol. 2009. 26:185–189.

19. American Academy of Pediatrics Committee on Nutrition: nutritional needs of low-birth-weight infants. Pediatrics. 1985. 75:976–986.

20. Ziegler EE, Thureen PJ, Carlson SJ. Aggressive nutrition of the very low birthweight infant. Clin Perinatol. 2002. 29:225–244.

21. Rigo J, Curtis MD. Guandalini S, editor. Parenteral nutrition in premature infants. Textbook of Pediatric Gastroenterology and nutrition. 2004. 1st ed. Talyor & Francis Group;619–638.

22. Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM. Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics. 1988. 82:527–532.

23. Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986. 33:179–201.

24. 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. 92:529–534.

25. Kilbride HW, Cater G, Warady BA. Early onset hyperkalemia in extremely low birth weight infants. J Perinatol. 1988. 8:211–214.

26. Omar SA, DeCristofaro JD, Agarwal BI, LaGamma EF. Effect of prenatal steroids on potassium balance in extremely low birth weight neonates. Pediatrics. 2000. 106:561–567.

27. Uga N, Nemoto Y, Ishii T, Kawase Y, Arai H, Tada H. Antenatal steroid treatment prevents severe hyperkalemia in very low-birth-weight infants. Pediatr Int. 2003. 45:656–660.

28. Vasarhelyi B, Tulassay T, Ver A, Dobos M, Kocsis I, Seri I. Developmental changes in erythrocyte Na(+),K(+)-ATPase subunit abundance and enzyme activity in neonates. Arch Dis Child Fetal Neonatal Ed. 2000. 83:F135–F138.

29. Scholle S, Bräunlich H. Effects of prenatally administered thyroid hormones or glucocorticoids on maturation of kidney function in newborn rats. Dev Pharmacol Ther. 1989. 12:162–168.

30. Hung KC, Su BH, Lin TW, Peng CT, Tsai CH. Glucose-insulin infusion for the early treatment of non-oliguric hyperkalemia in extremely-low-birth-weight infants. Acta Paediatr Taiwan. 2001. 42:282–286.

31. De Luca D, Paolillo P. Absence of arrhythmias in the extremely preterm heart with severe hyperkalaemia. Resuscitation. 2009. 80:961.

32. Fukuda Y, Kojima T, Ono A, Matsuzaki S, Iwase S, Kobayashi Y. Factors causing hyperkalemia in premature infants. Am J Perinatol. 1989. 6:76–79.

33. Iijima S, Uga N, Kawase Y, Tada H. Prophylactic calcium administration for hyperkalemia in extremely low birthweight infants. Am J Perinatol. 2005. 22:211–216.