Neonatal Med.  2020 May;27(2):82-88. 10.5385/nm.2020.27.2.82.

Association between Serum Hyponatremia and Severity of Respiratory Symptoms in Infants with Respiratory Syncytial Virus Infection

• Yum SO
• Kim HH
• Kim JK

• KMID: 2503163
• DOI: http://doi.org/10.5385/nm.2020.27.2.82

Abstract

Purpose
Association between hyponatremia and the severity of respiratory symptoms in infants with respiratory syncytial virus (RSV) infection has not yet been studied. This study aimed to compare respiratory symptoms, assessed using the Pediatric Respiratory Score (PRS), in infants with RSV infection, with or without hyponatremia.
Methods
RSV­positive patients aged <12 months who were admitted with respiratory symptoms within 7 days of onset at Jeonbuk National University Children’s Hospital from January 2016 to December 2019 were retrospectively analyzed. Each patient was categorized into those with or without hyponatremia (serum sodium concentration of <136 mmol/L). Clinical findings included PRS on the day of admission.
Results
The mean±standard deviation age of the 125 patients included in the study was 2.7±3.3 months, and, 20 patients (16.0%) showed hyponatremia. Infants with RSV infection and hyponatremia had lower birth weights, longer hospital stays, and higher blood urea nitrogen level. The C­reactive protein level was significantly higher in the hyponatremic infants, who had higher PRSs. The non­hyponatremia group had more normal PRSs than the hyponatremia group, which had more severe PRSs. After adjustment for age at admission, blood urea nitrogen level (OR, 1.218; 95% CI, 1.023 to 1.451; P<0.05), and PRS grade (OR, 2.885; 95% CI, 1.158 to 7.187; P< 0.05) were identified as independent risk factors.
Conclusion
Hyponatremia was strongly associated with respiratory severity in infants with RSV. Therefore, infants admitted with RSV infection who show higher PRS grade need to be evaluated and treated for hyponatremia.

Keyword

Hyponatremia; Respiratory syncytial viruses; Pediatric respiratory score

Figure

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  Figure 1. Frequency distributions of serum sodium concentration and pediatric respiratory severity (PRS) among infants with respiratory syncytial virus infection at admission.

Reference

1. Eisenhut M. Extrapulmonary manifestations of severe respiratory syncytial virus infection: a systematic review. Crit Care. 2006; 10:R107.

2. Hanna S, Tibby SM, Durward A, Murdoch IA. Incidence of hyponatraemia and hyponatraemic seizures in severe respiratory syncytial virus bronchiolitis. Acta Paediatr. 2003; 92:430–4.

3. Willson DF, Landrigan CP, Horn SD, Smout RJ. Complications in infants hospitalized for bronchiolitis or respiratory syncytial virus pneumonia. J Pediatr. 2003; 143(5 Suppl):S142–9.

4. Park SW, Shin SM, Jeong M, Cho DH, Lee KH, Eisenhut M, et al. Hyponatremia in children with respiratory infections: a cross-sectional analysis of a cohort of 3938 patients. Sci Rep. 2018; 8:16494.

5. Rutman L, Migita R, Spencer S, Kaplan R, Klein EJ. Standardized asthma admission criteria reduce length of stay in a pediatric emergency department. Acad Emerg Med. 2016; 23:289–96.

6. Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med. 2000; 342:1581–9.

7. Hoorn EJ, Zietse R. Diagnosis and treatment of hyponatremia: compilation of the guidelines. J Am Soc Nephrol. 2017; 28:1340–9.

8. Seifert ME, Welak SR, Carroll CL. Hyponatremia is associated with increased severity of disease in critically ill children with bronchiolitis. Int J Clin Med. 2010; 1:37–40.

9. Sockrider M, Katkin J. What is respiratory syncytial virus (RSV)? Am J Respir Crit Care Med. 2015; 191:P3–4.

10. Kanai H, Sato Y, Ichihashi K. Hyponatremia in patients with respiratory syncytial virus bronchiolitis. Pediatric Health Med Ther. 2012; 3:39–43.

11. McAdams RM, Hedstrom AB, DiBlasi RM, Mant JE, Nyonyintono J, Otai CD, et al. Implementation of bubble CPAP in a rural Ugandan neonatal ICU. Respir Care. 2015; 60:437–45.

12. Rusmawati A, Haksari EL, Naning R. Downes score as a clinical assessment for hypoxemia in neonates with respiratory distress. Paediatr Indones. 2008; 48:342–5.

13. Gozal D, Colin AA, Jaffe M, Hochberg Z. Water, electrolyte, and endocrine homeostasis in infants with bronchiolitis. Pediatr Res. 1990; 27:204–9.

14. Szabo FK, Lomenick JP. Syndrome of inappropriate antidiuretic hormone secretion in an infant with respiratory syncytial virus bronchiolitis. Clin Pediatr (Phila). 2008; 47:840–2.

15. Rao M, Eid N, Mitchell M, Steiner P. Hyperinflation (airtrapping) as a stimulant of ADH response in children with chronic asthma. Pediatr Res. 1985; 19:413.

16. Chaitra KM, Mohan Kumar N, Saipraneeth Reddy G. Hyponatremia in lower respiratory tract infections. Int J Contemp Pediatrics. 2016; 3:381–4.

17. Picone S, Mondì V, Di Palma F, Martini L, Paolillo P. Neonatal encephalopathy and SIADH during RSV infection. Am J Perinatol. 2019; 36:S106–9.

18. Kawashima H, Ioi H, Ushio M, Yamanaka G, Matsumoto S, Nakayama T. Cerebrospinal fluid analysis in children with seizures from respiratory syncytial virus infection. Scand J Infect Dis. 2009; 41:228–31.

19. Kloiber LL, Winn NJ, Shaffer SG, Hassanein RS. Late hyponatremia in very-low-birth-weight infants: incidence and associated risk factors. J Am Diet Assoc. 1996; 96:880–4.

20. Sulyok E, Kovacs L, Lichardus B, Michajlovskij N, Lehotska V, Nemethova V, et al. Late hyponatremia in premature infants: role of aldosterone and arginine vasopressin. J Pediatr. 1985; 106:990–4.

21. Sahay M, Sahay R. Hyponatremia: a practical approach. Indian J Endocrinol Metab. 2014; 18:760–71.