극소 저 체중 미숙아에서 생후 7일 이내 나트륨 투여량과 뇌실내 출혈의 상관성 분석
Association between Sodium Intake and Intraventricular Hemorrhage in Preterm Infants
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Background : Intraventricular hemorrhage (IVH), the most common type of neonatal intracranial hemorrhage, can cause neurodevelopmental impairment or death. A study has shown that hypernatremia is associated with IVH in term infants however, it did clearly document the role of sodium intake and hypernatremia in the pathogenesis of IVH in very low birth weight (VLBW) premature infants. The aim of this study was to aim determine the associations between sodium intake, hypernatremia and IVH in VLBW preterm infants. Methods : We conducted a retrospective case-cohort study of preterm infants with birth weight < 1.5 kg who were admitted to the neonatal intensive care unit of Asan Medical Center between December 2007 to December 2010. Serum sodium concentration, sodium intake, fluid and weight loss, which are the suggested risk factors of hypernatremia, and the incidence of IVH were evaluated. The sources of sodium intake were also examined. Results : Sodium intake > 4.5 mEq/kg/day on each of the first 3 days following birth was associated with hypernatremia along with the risk of IVH (Day 1 : p value 0.006, Day 2 : p value <0.001, Day 3 : p value < 0.001). The TPN was the major source of sodium intake representing 53 percent, followed by normal saline, ampicillin sodium and sodium bicarbonate. Conclusions : Increased sodium intake and hypernatremia may be risk factors for IVH in VLBW infants. We recommend more restriction of sodium inclusion in TPN in the first three postnatal days.
Abstract
Background : Intraventricular hemorrhage (IVH), the most common type of neonatal intracranial hemorrhage, can cause neurodevelopmental impairment or death. A study has shown that hypernatremia is associated with IVH in term infants however, it did clearly document the role of sodium intake and hypernatremia in the pathogenesis of IVH in very low birth weight (VLBW) premature infants. The aim of this study was to aim determine the associations between sodium intake, hypernatremia and IVH in VLBW preterm infants. Methods : We conducted a retrospective case-cohort study of preterm infants with birth weight < 1.5 kg who were admitted to the neonatal intensive care unit of Asan Medical Center between December 2007 to December 2010. Serum sodium concentration, sodium intake, fluid and weight loss, which are the suggested risk factors of hypernatremia, and the incidence of IVH were evaluated. The sources of sodium intake were also examined. Results : Sodium intake > 4.5 mEq/kg/day on each of the first 3 days following birth was associated with hypernatremia along with the risk of IVH (Day 1 : p value 0.006, Day 2 : p value <0.001, Day 3 : p value < 0.001). The TPN was the major source of sodium intake representing 53 percent, followed by normal saline, ampicillin sodium and sodium bicarbonate. Conclusions : Increased sodium intake and hypernatremia may be risk factors for IVH in VLBW infants. We recommend more restriction of sodium inclusion in TPN in the first three postnatal days.
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