Invited Reviews
Sodium Intake Requirements for Preterm Neonates
Review and Recommendations
Adrianne R. Bischoff,
Christopher Tomlinson,
Jaques Belik,
Adrianne R. Bischoff
Department of Pediatrics, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
Search for more papers by this authorChristopher Tomlinson
Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
Search for more papers by this authorCorresponding Author
Jaques Belik
Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
Address correspondence and reprint requests to Jaques Belik, MD, The Hospital for Sick Children Toronto, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 9th Floor, Room 09.9713, Toronto, ON M5G 0A4, Canada (e-mail: [email protected]).Search for more papers by this authorAdrianne R. Bischoff,
Christopher Tomlinson,
Jaques Belik,
Adrianne R. Bischoff
Department of Pediatrics, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
Search for more papers by this authorChristopher Tomlinson
Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
Search for more papers by this authorCorresponding Author
Jaques Belik
Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
Address correspondence and reprint requests to Jaques Belik, MD, The Hospital for Sick Children Toronto, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 9th Floor, Room 09.9713, Toronto, ON M5G 0A4, Canada (e-mail: [email protected]).Search for more papers by this authorThe present work was funded by a grant from the Canadian Institutes of Health Research (J.B.; MOP 133664).
The authors report no conflicts of interest.
ABSTRACT
It is widely accepted that sodium is an essential nutritional electrolyte and its deficiency is associated with neurological sequelae and poor growth. The provision of an adequate sodium intake to preterm neonates is hampered by the technical difficulty in clinically assessing total body sodium content. As addressed in this review, there is a lack of consensus on the definition of hyponatremia early in life, but there is no evidence that it should deviate from the widely accepted normative data for adult subjects. A low urinary sodium content is accepted by many as reflecting total body sodium deficiency, yet spot urinary sodium measurements are of questionable clinical value. The hormonal regulation of sodium homeostasis is here reviewed and the mechanism accounting for sodium deficiency–induced growth impairment in preterm infants addressed. Lastly, we provide evidence-based gestational and postnatal age-dependent recommendations for the provision of adequate sodium intake to preterm neonates.
REFERENCES
- 1.Gattineni J, Baum M. Developmental changes in renal tubular transport--an overview. Pediatr Nephrol 2015; 30: 2085–2098.
- 2.Baraton L, Ancel PY, Flamant C, et al. Impact of changes in serum sodium levels on 2-year neurologic outcomes for very preterm neonates. Pediatrics 2009; 124: e655–e661.
- 3.Al-Dahhan J, Jannoun L, Haycock G. Effect of salt supplementation of newborn premature infants on neurodevelopmental outcome at 10-13 years of age. Arch Dis Child Fetal Neonatal Ed 2002; 86: F120–F123.
- 4.Murphy DJ, Hope PL, Johnson A. Neonatal risk factors for cerebral palsy in very preterm babies: case-control study. BMJ 1997; 314: 404–408.
- 5.Li YF, Lu GJ, Han YK. Risk factors for intracranial hemorrhage in very low birth weight infants. Zhongguo Dang Dai Er Ke Za Zhi 2007; 9: 297–300.
- 6.Ertl T, Hadzsiev K, Vincze O, et al. Hyponatremia and sensorineural hearing loss in preterm infants. Biol Neonate 2001; 79: 109–112.
- 7.Chance GW, Radde IC, Willis DM, et al. Postnatal growth of infants of less than 1.3 kg birth weight: effects of metabolic acidosis, of caloric intake, and of calcium, sodium, and phosphate supplementation. J Pediatr 1977; 91: 787–793.
- 8.Vanpee M, Herin P, Broberger U, et al. Sodium supplementation optimizes weight gain in preterm infants. Acta Paediatr 1995; 84: 1312–1314.
- 9.Isemann B, Mueller EW, Narendran V, et al. Impact of early sodium supplementation on hyponatremia and growth in premature infants: a randomized controlled trial. JPEN J Parenter Enteral Nutr 2016; 40: 342–349.
- 10.Kim YJ, Lee JA, Oh S, et al. Risk factors for late-onset hyponatremia and its influence on neonatal outcomes in preterm infants. J Korean Med Sci 2015; 30: 456–462.
- 11.Al-Dahhan J, Haycock GB, Nichol B, et al. Sodium homeostasis in term and preterm neonates. III. Effect of salt supplementation. Arch Dis Child 1984; 59: 945–950.
- 12.Greenberg A, Verbalis JG, Amin AN, et al. Current treatment practice and outcomes. Report of the hyponatremia registry. Kidney Int 2015; 88: 167–177.
- 13.Shirazki A, Weintraub Z, Reich D, et al. Lowest neonatal serum sodium predicts sodium intake in low birth weight children. Am J Physiol Regul Integr Comp Physiol 2007; 292: R1683–R1689.
- 14.Kim Y-J, Lee JA, Oh S, et al. Risk factors for late-onset hyponatremia and its influence on neonatal outcomes in preterm infants. J Korean Med Sci 2015; 30: 456–462.
- 15.Marcialis MA, Dessi A, Pintus MC, et al. Neonatal hyponatremia: differential diagnosis and treatment. J Matern Fetal Neonatal Med 2011; 24 (suppl 1): 75–79.
- 16.Forbes GB, Perley A. Estimation of total body sodium by isotopic dilution. II. Studies on infants and children: an example of a constant differential growth ratio. J Clin Invest 1951; 30: 566–574.
- 17.Corsa L, Gribetz D, Cook CD, et al. Total body exchangeable water, sodium and potassium in hospital normal infants and children. Pediatrics 1956; 17: 184–191.
- 18.Butterworth SA, Lalari V, Dheensaw K. Evaluation of sodium deficit in infants undergoing intestinal surgery. J Pediatr Surg 2014; 49: 736–740.
- 19.Bower TR, Pringle KC, Soper RT. Sodium deficit causing decreased weight gain and metabolic acidosis in infants with ileostomy. J Pediatr Surg 1988; 23: 567–572.
- 20.O’Neil M, Teitelbaum DH, Harris MB. Total body sodium depletion and poor weight gain in children and young adults with an ileostomy: a case series. Nutr Clin Pract 2014; 29: 397–401.
- 21.Mansour F, Petersen D, De Coppi P, et al. Effect of sodium deficiency on growth of surgical infants: a retrospective observational study. Pediatr Surg Int 2014; 30: 1279–1284.
- 22.Doenyas-Barak K, Beberashvili I, Bar-Chaim A, et al. Daily sodium and potassium excretion can be estimated by scheduled spot urine collections. Nephron 2015; 130: 35–40.
- 23.Colin-Ramirez E, Arcand J, Ezekowitz JA. Estimates of dietary sodium consumption in patients with chronic heart failure. J Card Fail 2015; 21: 981–988.
- 24.McLean RM. Measuring population sodium intake: a review of methods. Nutrients 2014; 6: 4651–4662.
- 25.Rhee MY, Kim JH, Shin SJ, et al. Estimation of 24-hour urinary sodium excretion using spot urine samples. Nutrients 2014; 6: 2360–2375.
- 26.Mann M, Waz W, Poupoulos J, et al. Urinary sodium to creatinine ratio in healthy infants. Clin Pediatr 2012; 51: 852–855.
- 27.Boehm G, Wiener M, Schmidt C, et al. Usefulness of short-term urine collection in the nutritional monitoring of low birthweight infants. Acta Paediatr 1998; 87: 339–343.
- 28.Sacher P, Hirsig J, Gresser J, et al. The importance of oral sodium replacement in ileostomy patients. Prog Pediatr Surg 1989; 24: 226–231.
- 29.Schwarz KB, Ternberg JL, Bell MJ, et al. Sodium needs of infants and children with ileostomy. J Pediatr 1983; 102: 509–513.
- 30.Trotter A, Stoll M, Leititis JU, et al. Circadian variations of urinary electrolyte concentrations in preterm and term infants. J Pediatr 1996; 128: 253–256.
- 31.Gallini F, Maggio L, Romagnoli C, et al. Progression of renal function in preterm neonates with gestational age < or = 32 weeks. Pediatr Nephrol 2000; 15: 119–124.
- 32.Ross B, Cowett RM, Oh W. Renal functions of low birth weight infants during the first two months of life. Pediatr Res 1977; 11: 1162–1164.
- 33.Gubhaju L, Sutherland MR, Horne RS, et al. Assessment of renal functional maturation and injury in preterm neonates during the first month of life. Am J Physiol Renal Physiol 2014; 307: F149–F158.
- 34.Giapros VI, Papaloukas AL, Andronikou SK. Urinary mineral excretion in preterm neonates during the first month of life. Neonatology 2007; 91: 180–185.
- 35.Aperia A, Broberger O, Herin P, et al. Sodium excretion in relation to sodium intake and aldosterone excretion in newborn pre-term and full-term infants. Acta Paediatr Scand 1979; 68: 813–817.
- 36.Koo WW, Succop P, Gupta JM. Urinary sodium excretion in young infants: role of gestational and postnatal ages. Aust Paediatr J 1988; 24: 153–156.
- 37.Costarino AT, Gruskay JA, Corcoran L, et al. Sodium restriction versus daily maintenance replacement in very low birth weight premature neonates: a randomized, blind therapeutic trial. J Pediatr 1992; 120: 99–106.
- 38.Sulyok E, Rascher W, Baranyai Z, et al. Influence of NaCl supplementation on vasopressin secretion and water excretion in premature infants. Biol Neonate 1993; 64: 201–208.
- 39.Lee BS, Byun SY, Chung ML, et al. Effect of furosemide on ductal closure and renal function in indomethacin-treated preterm infants during the early neonatal period. Neonatology 2010; 98: 191–199.
- 40.Tugay S, Bircan Z, Cağlayan C, et al. Acute effects of gentamicin on glomerular and tubular functions in preterm neonates. Pediatr Nephrol 2006; 21: 1389–1392.
- 41.Rothberg AD, Andronikou S. Effect of tobramycin on fractional sodium excretion in neonates. Pediatr Pharmacol (New York) 1984; 4: 49–52.
- 42.Giapros VI, Andronikou SK, Cholevas VI, et al. Renal function and effect of aminoglycoside therapy during the first ten days of life. Pediatr Nephrol 2003; 18: 46–52.
- 43.Shirley DG, Walter SJ, Noormohamed FH. Natriuretic effect of caffeine: assessment of segmental sodium reabsorption in humans. Clin Sci (Lond) 2002; 103: 461–466.
- 44.Fenton RA, Poulsen SB, De la Mora Chavez S, et al. Caffeine-induced diuresis and natriuresis is independent of renal tubular NHE3. Am J Physiol Renal Physiol 2015; 308: F1409–F1420.
- 45.Liu C, Zhao Q, Zhen Y, et al. The effect of corticosteroid on renal water and sodium excretion in symptomatic heart failure: prednisone for renal function improvement evaluation study. J Cardiovasc Pharmacol 2015; 66: 316–322.
- 46.Banday AA, Lokhandwala MF. Novel gastro-renal axis and sodium regulation during hypertension. Hypertension 2013; 62: 834–835.
- 47.Aperia A. Renal dopamine system and salt balance. Am J Kidney Dis 1998; 31: xliii–xlv.
- 48.Appel LJ, Baker DH, Bar-Or O, et al. Dietary references intake for water, potassium, sodium, chloride, and sulfate. Panel on dietary reference intakes for electrolytes and water, standing committee on the scientific evaluation of dietary reference intakes, Food and Nutrition Board. Institute of Medicine of the National Academies. 2005; Washington, DC: National Academies Press, 269–423.
- 49.Shaffer SG, Meade VM. Sodium balance and extracellular volume regulation in very low birth weight infants. J Pediatr 1989; 115: 285–290.
- 50.Aviv A, Kobayashi T, Higashino H, et al. Chronic sodium deficit in the immature rat: its effect on adaptation to sodium excess. Am J Physiol 1982; 242: E241–E247.
- 51.Wassner SJ. Altered growth and protein turnover in rats fed sodium-deficient diets. Pediatr Res 1989; 26: 608–613.
- 52.Wassner SJ. The effect of sodium repletion on growth and protein turnover in sodium-depleted rats. Pediatr Nephrol 1991; 5: 501–504.
- 53.Schwarz KB, Keating JP, Ternberg JL, et al. Sodium balance following Soave ileo-endorectal pull-through. J Pediatr Surg 1977; 12: 945–953.
- 54.Haycock GB. The influence of sodium on growth in infancy. Pediatr Nephrol 1993; 7: 871–875.
- 55.Aredia F, Giansanti V, Mazzini G, et al. Multiple effects of the Na(+)/H (+) antiporter inhibitor HMA on cancer cells. Apoptosis 2013; 18: 1586–1598.
- 56.Hisamitsu T, Nakamura TY, Wakabayashi S. Na(+)/H(+) exchanger 1 directly binds to calcineurin A and activates downstream NFAT signaling, leading to cardiomyocyte hypertrophy. Mol Cell Biol 2012; 32: 3265–3280.
- 57.Grinstein S, Rotin D, Mason MJ. Na+/H+ exchange and growth factor-induced cytosolic pH changes. Role in cellular proliferation. Biochim Biophys Acta 1989; 988: 73–97.
- 58.Mendoza SA. The Na+-H+ antiport is a mediator of cell proliferation. Acta Paediatr Scand 1987; 76: 545–547.
- 59.Seifter JL, Aronson PS. Properties and physiologic roles of the plasma membrane sodium-hydrogen exchanger. J Clin Invest 1986; 78: 859–864.
- 60. Medicine Io. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. 2005; Washington, DC: The National Academies Press, 640.
- 61.Agostoni C, Buonocore G, Carnielli VP, et al. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr 2010; 50: 85–91.
- 62.Tudehope D, Fewtrell M, Kashyap S, et al. Nutritional needs of the micropreterm infant. J Pediatr 2013; 162 (3 suppl): S72–S80.
- 63.O’Brien F, Walker IA. Fluid homeostasis in the neonate. Paediatr Anaesth 2014; 24: 49–59.
- 64.Bidiwala KS, Lorenz JM, Kleinman LI. Renal function correlates of postnatal diuresis in preterm infants. Pediatrics 1988; 82: 50–58.
- 65.Lorenz JM, Kleinman LI, Ahmed G, et al. Phases of fluid and electrolyte homeostasis in the extremely low birth weight infant. Pediatrics 1995; 96 (3 pt 1): 484–489.
- 66.Bert S, Gouyon JB, Semama DS. Calcium, sodium and potassium urinary excretion during the first five days of life in very preterm infants. Biol Neonate 2004; 85: 37–41.
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