Abstract
BackgroundNew national guidelines recommend more restricted fluid intake and early initiation of total parenteral nutrition (TPN) in very preterm infants. The aim was study the effect of these guidelines on serum sodium and potassium levels and fluid balance in the first three days after birth.MethodsTwo cohorts of infants <28 weeks gestational age, born at the Leiden University Medical Center in the Netherlands, were compared retrospectively before (2002–2004, late-TPN) and after (2006–2007, early-TPN) introduction of the new Dutch guideline. Outcome measures were serum sodium and potassium levels, diuresis, and changes in body weight in the first three postnatal days.ResultsIn the first three postnatal days no differences between late-TPN (N = 70) and early-TPN cohort (N = 73) in mean (SD) serum sodium (141.1 (3.8) vs 141.0 (3.7) mmol/l) or potassium (4.3 (0.5) vs 4.3 (0.5) mmol/l) were found, but in the early-TPN cohort diuresis (4.5 (1.6) vs 3.2 (1.4) ml/kg/h) and loss of body weight were decreased (−6.0% (7.7) vs −0.8% (8.0)).ConclusionsInitiation of TPN immediately after birth and restricted fluid intake in very preterm infants do not seem to influence serum sodium and potassium levels in first three postnatal days. Further research is needed to see if a decreased diuresis and loss of body weight in the first days is the result of a delayed postnatal adaptation or better energy balance.
Highlights
During the first days of life very preterm infants are almost entirely dependent on total parenteral nutrition (TPN) to meet their energy and nutritional requirements.[1]
In the first postnatal days disturbances in the fluid and electrolyte balance occur frequently in very preterm infants as a result of high insensible water loss and renal immaturity.[6,7,8,9]. This imbalance can lead to major complications, such as neurological impairment and cardiac arrhythmia caused by hypernatraemia and hyperkalaemia respectively.[4,9,10,11]
During both study periods a total of 166 inborn infants with gestational age,28 weeks were admitted to the neonatal unit
Summary
During the first days of life very preterm infants are almost entirely dependent on total parenteral nutrition (TPN) to meet their energy and nutritional requirements.[1] Soon after birth preterm infants are at risk for catabolism. Administration of TPN, including amino acids, directly after birth has beneficial effects on their nitrogen balance, neonatal growth, and health.[1,2,3] Intake of fluid and electrolytes is accomplished by TPN as well. New national guidelines recommend more restricted fluid intake and early initiation of total parenteral nutrition (TPN) in very preterm infants. The aim was study the effect of these guidelines on serum sodium and potassium levels and fluid balance in the first three days after birth
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