J Korean Med Sci.  2015 Mar;30(3):283-289. 10.3346/jkms.2015.30.3.283.

Early Sodium and Fluid Intake and Severe Intraventricular Hemorrhage in Extremely Low Birth Weight Infants

• Lee HJ
• Lee BS
• Do HJ
• Oh SH
• Choi YS
• Chung SH
• Kim EA
• Kim KS

• KMID: 2133306
• DOI: http://doi.org/10.3346/jkms.2015.30.3.283

Abstract

Hypernatremic dehydration is an important cause of intracranial hemorrhage. A possible association of intraventricular hemorrhage (IVH) with hypernatremia and/or high sodium intake has been suggested in preterm infants. To investigate the associations of early fluid and sodium intake or serum sodium concentrations with severe intraventricular hemorrhage (IVH) in extremely low birth weight (ELBW) infants, we reviewed the medical records of 169 inborn ELBW infants. Daily fluid and sodium intake, urine output, weight loss and serum sodium concentration during the first 4 days of life were obtained. Patients were divided into the severe IVH (grade 3/4) and the control (no or grade 1/2 IVH) group. The maximum serum sodium concentration and the incidence of hypernatremia did not differ between the two groups. Related to the fluid balance and sodium intake, the risk for severe IVH was strongly associated with total fluid and sodium intake during the initial four days of life. With respect to the fluids other than transfusion, severe IVH can be discriminated only by sodium intake but not by fluid intake. Large randomized controlled trials are required to clarify the causal relationship between the early sodium intake and severe IVH in ELBW infants.

Keyword

Sodium; Intraventricular Hemorrhage; Hypernatremia; Fluid Therapy; Infant, Extremely Low Birth Weight; Infant, Premature

MeSH Terms

Birth Weight
Dehydration
Drinking
Heart Ventricles/*pathology
Hemorrhage/mortality/*pathology
Humans
Hypernatremia/*blood
Infant
Infant Mortality
Infant, Extremely Low Birth Weight/*blood
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases/epidemiology
Retrospective Studies
Sodium/*blood
Sodium, Dietary
Sodium
Sodium, Dietary

Figure

• 

  Fig. 1 Comparison of fluid and sodium intake between the study groups. The box plots represent the fluid volume (A, B, C) and sodium intake (D, E, F) from total fluids, transfusion and the fluids other than transfusion, respectively. The bottom and top of the box represent the first and third quartiles and the band inside the box is the median value.

• 

  Fig. 2 Receiver operating characteristic (ROC) curves of severe intraventricular hemorrhage in the association of fluid intake (dot line) and sodium intake (solid line) in total fluids (A), transfusion (B) and the fluids other than transfusion (C). The area of under the curve (AUC) value of each plot is presented in the separate table under the figure.

• 

  Fig. 3 The gestational age and transfusion-adjusted odds ratio of severe intraventricular hemorrhage plotted with the mean fluid (A, B, C) and sodium intake (D, E, F) from total fluids, transfusion and the fluids other than transfusion on day 1 to 3 after birth, respectively. *Odds ratio with P value < 0.05.

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