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Wasik HL, Harvey E, Neu A. Peritoneal dialysis in children, what's different: Your questions answered. Perit Dial Int 2024; 44:365-373. [PMID: 39313227 DOI: 10.1177/08968608241273633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
Maintenance peritoneal dialysis (PD) is the most used kidney replacement therapy for children with kidney failure throughout the world. Underlying causes of kidney failure, indications for dialysis, body size, and nutritional requirements differ between children and adults on PD. These differences, along with the ongoing growth and development that occurs throughout childhood, impact PD access, prescription, and monitoring in children. This review highlights the unique challenges and management approaches to optimize the care of children on maintenance PD.
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Affiliation(s)
- Heather L Wasik
- Division of Pediatric Nephrology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Elizabeth Harvey
- Division of Pediatric Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Alicia Neu
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Nelms CL, Shroff R, Boyer O, Topaloglu R. Managing the Nutritional Requirements of the Pediatric End-Stage Kidney Disease Graduate. Adv Chronic Kidney Dis 2022; 29:283-291. [PMID: 36084975 DOI: 10.1053/j.ackd.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/11/2022]
Abstract
The pediatric patient with end-stage kidney disease who transitions to the adult dialysis unit or nephrology center requires a unique nutritional focus. Clinicians in the adult center may be faced with complex issues that have often been part of the patient's journey since early childhood. The causes of kidney disease in children are often quite different than those which affect the adult population and may require different nutritional priorities. Abnormal growth including severe short stature, underweight, overweight or obesity, and poor musculature may affect the long-term health and psychosocial well-being of these patients. Nutritional assessment of these patients should include a focus on past growth and anthropometric data, dietary information, including appetite, quality of diet, and assessment of biochemical data through a pediatric lens. This review discusses the unique factors that must be considered when transitioning pediatric patients and notes major recommendations from a compilation of pediatric guideline statements.
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Affiliation(s)
| | - Rukshana Shroff
- UCL Great Ormond Street Hospital Institute of Child Health, London, UK
| | - Olivia Boyer
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Service Néphrologie Pédiatrique, Centre de référence MARHEA, Institut Imagine, Université Paris Cité, Paris, France
| | - Rezan Topaloglu
- Hacettepe University School of Medicine Department of Pediatric Nephrology, Ankara, Turkey.
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Park JS, Jeong SA, Cho JY, Seo JH, Lim JY, Woo HO, Youn HS, Park CH. Risk Factors and Effects of Severe Late-Onset Hyponatremia on Long-Term Growth of Prematurely Born Infants. Pediatr Gastroenterol Hepatol Nutr 2020; 23:472-483. [PMID: 32953643 PMCID: PMC7481060 DOI: 10.5223/pghn.2020.23.5.472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/13/2020] [Accepted: 05/16/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Sodium is an essential nutritional electrolyte that affects growth. A low serum sodium concentration in healthy premature infants beyond 2 weeks of life is called late-onset hyponatremia (LOH). Here, we investigated the association between LOH severity and growth outcomes in premature infants. METHODS Medical records of premature infants born at ≤32 weeks of gestation were reviewed. LOH was defined as a serum sodium level <135 mEq/L regardless of sodium replacement after 14 days of life. Cases were divided into two groups, <130 mEq/L (severe) and ≥130 mEq/L (mild). Characteristics and growth parameters were compared between the two groups. RESULTS A total of 102 premature infants with LOH were included. Gestational age ([GA] 27.7 vs. 29.5 weeks, p<0.001) and birth weight (1.04 vs. 1.34 kg, p<0.001) were significantly lower in the severe group. GA was a risk factor of severe LOH (odds ratio [OR], 1.328, p=0.022), and severe LOH affected the development of bronchopulmonary dysplasia (OR, 2.950, p=0.039) and led to a poor developmental outcome (OR, 9.339, p=0.049). Growth parameters at birth were lower in the severe group, and a lower GA and sepsis negatively affected changes in growth for 3 years after adjustment for time. However, severe LOH was not related to growth changes in premature infants. CONCLUSION Severe LOH influenced the development of bronchopulmonary dysplasia and developmental outcomes. However, LOH severity did not affect the growth of premature infants beyond the neonatal period.
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Affiliation(s)
- Ji Sook Park
- Department of Pediatrics, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Seul-Ah Jeong
- Department of Pediatrics, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Jae Young Cho
- Department of Pediatrics, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Ji-Hyun Seo
- Department of Pediatrics, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Jae Young Lim
- Department of Pediatrics, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Hyang Ok Woo
- Department of Pediatrics, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Hee-Shang Youn
- Department of Pediatrics, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Chan-Hoo Park
- Department of Pediatrics, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
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Gokçe İK, Oguz SS. Late onset hyponatremia in preterm newborns: is the sodium content of human milk fortifier insufficient? J Matern Fetal Neonatal Med 2018; 33:1197-1202. [PMID: 30149743 DOI: 10.1080/14767058.2018.1517314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: In this study, we aimed to define the incidence and time to detection of late onset hyponatremia (LOH) as well as factors affecting its development in preterm newborns. We also aimed to determine the daily sodium requirement of these patients.Methods: We studied a total of 145 very low birth weight infants with a full or nearly full enteral diet and followed them up until discharge. We recorded demographic and clinic characteristics. We measured serum sodium (SNa) levels at least once a week after the second week. We compared infants with LOH with other infants to analyze possible risk factors.Results: Twenty-nine (20%) infants developed LOH in an average of 23.4 ± 7.8 days. The mean SNa level of these infants was 124.6 ± 5.6 mmol/L. Logistic regression analysis showed that a birth weight of less than 1000 g, preterm early membrane rupture, and nutrition with fortified human milk alone were risk factors for LOH. The mean daily amount of sodium added to the nutrition of hyponatremic preterm infants was 3.6 ± 2.1 mmol/L. Subgroup analysis showed that the incidence of LOH was two times higher (39.2%) in infants with a birth weight of less than 1000 g.Conclusion: We observed the development of LOH within three to four weeks in nearly half of preterm infants fed with fortified human milk, especially those with a birth weight of less than 1000 g. We believe that the sodium content of currently used human milk fortifiers should be increased.
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Affiliation(s)
| | - Serife Suna Oguz
- Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
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Sethi SK, Maxvold N, Bunchman T, Jha P, Kher V, Raina R. Nutritional management in the critically ill child with acute kidney injury: a review. Pediatr Nephrol 2017; 32:589-601. [PMID: 27324472 DOI: 10.1007/s00467-016-3402-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 04/07/2016] [Accepted: 04/08/2016] [Indexed: 12/26/2022]
Abstract
Acute kidney injury (AKI) in critically ill children is frequently a component of the multiple organ failure syndrome. It occurs within the framework of the severe catabolic phase determined by critical illness and is intensified by metabolic derangements. Nutritional support is a must for these children to improve outcomes. Meeting the special nutritional needs of these children often requires nutritional supplementation by either the enteral or the parenteral route. Since critically ill children with AKI comprise a heterogeneous group of subjects with varying nutrient needs, nutritional requirements should be frequently reassessed, individualized and carefully integrated with renal replacement therapy. This article is a state-of-the-art review of nutrition in critically ill children with AKI.
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Affiliation(s)
- Sidharth Kumar Sethi
- Kidney and Urology Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, 122001, India
| | - Norma Maxvold
- Children's Hospital of Richmond, VCU School of Medicine, McGuire Hall Annex, Richmond, VA, 23298, USA
| | - Timothy Bunchman
- Children's Hospital of Richmond, VCU School of Medicine, McGuire Hall Annex, Richmond, VA, 23298, USA
| | - Pranaw Jha
- Kidney and Urology Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, 122001, India
| | - Vijay Kher
- Kidney and Urology Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, 122001, India
| | - Rupesh Raina
- Department of Pediatric Nephrology, Akron Children Hospital, Akron, OH, USA.
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Implantation and pregnancy outcome of Sprague–Dawley rats fed with low and high salt diet. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2016.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Knepper C, Ellemunter H, Eder J, Niedermayr K, Haerter B, Hofer P, Scholl-Bürgi S, Müller T, Heinz-Erian P. Low sodium status in cystic fibrosis-as assessed by calculating fractional Na(+) excretion-is associated with decreased growth parameters. J Cyst Fibros 2016; 15:400-5. [PMID: 26777601 DOI: 10.1016/j.jcf.2015.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/03/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND In CF infants, normonatremic Na(+) depletion (NNaD), identified by fractional Na(+) excretion (FENa) values <0.5%, was recently linked to impaired growth. Our paper investigates the relationship between FENa and growth in CF children >2years. METHODS FENa values were calculated in 35 CF and 24 control children, and tested for correlations with z-scores for weight, height and BMI. RESULTS All CF children and controls had normal plasma Na(+) concentrations. A total of 25 of 35 (71.4%) CF patients had decreased FENa values <0.5% (group I). FENa results of 10 CF patients (group II) and 23/24 controls (group III) were normal. In Na(+)-depleted CF children, compared to normal controls, mean z-scores for weight (-0.18±0.87 vs +1.03±0.57, p<0.001), height (-0.06±0.89 vs +0.53±0.72, p=0.009) and BMI (-0.22±0.87 vs +1.00±1.06, p<0.001) were significantly reduced. Also, we found positive correlations between FENa values and z-scores for weight (r=0.521), height (r=0.292) and BMI (r=0.468), respectively. CONCLUSION NNaD may contribute to poor growth in CF.
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Affiliation(s)
- Christiane Knepper
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Helmut Ellemunter
- Department of Pediatrics III, Cystic Fibrosis Center, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Eder
- Department of Pediatrics III, Cystic Fibrosis Center, Medical University of Innsbruck, Innsbruck, Austria
| | - Katharina Niedermayr
- Department of Pediatrics III, Cystic Fibrosis Center, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina Haerter
- Department of General and Transplant Surgery, Division of Pediatric Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Hofer
- Division of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Sabine Scholl-Bürgi
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Müller
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Heinz-Erian
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria.
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Isemann B, Mueller EW, Narendran V, Akinbi H. Impact of Early Sodium Supplementation on Hyponatremia and Growth in Premature Infants: A Randomized Controlled Trial. JPEN J Parenter Enteral Nutr 2014; 40:342-9. [PMID: 25406227 DOI: 10.1177/0148607114558303] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 10/07/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND We tested the hypothesis that sodium supplementation in early preterm infants prevents late-onset hyponatremia and improves growth without increasing common morbidities during birth hospitalization. MATERIALS AND METHODS This was a randomized, masked controlled trial of 4 mEq/kg/d of sodium (intervention) versus sterile water (placebo) from days-of-life 7 to 35 in infants born at <32 weeks corrected gestational age. The primary outcome was weight gain in the first 6 weeks of life. Secondary outcomes included weekly serum sodium concentrations, growth in body length and head circumference, and complications of prematurity during birth hospitalization. RESULTS Fifty-three infants with an average corrected gestational age of 28.5 ± 2.4 weeks were randomized. Infants receiving the intervention had fewer (P = .012) reports of serum sodium concentrations <135 mmol/L and greater velocity of weight gain during the study period, mean (SD) 26.9 (3.1) vs 22.9 (4.7) g/kg/day, P = .012. At 6 weeks of age, infants <28 weeks' gestation who received sodium supplementation had greater percentage weight change from birth, mean (SD) 193% (22%) vs 173% (10%), P = .041, and maintained fetal reference birth percentile for body weight more often (P = .002) compared with infants receiving placebo. Growth in length and head circumference was not significantly different between study arms. No increase in common prematurity-related morbidities was detected in infants who received supplemental sodium chloride. CONCLUSION Sodium supplementation of enteral feedings in very premature infants averts hyponatremia and enhances weight gain.
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Affiliation(s)
| | - Eric W Mueller
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Vivek Narendran
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Henry Akinbi
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Warady BA, Neu AM, Schaefer F. Optimal Care of the Infant, Child, and Adolescent on Dialysis: 2014 Update. Am J Kidney Dis 2014; 64:128-42. [DOI: 10.1053/j.ajkd.2014.01.430] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 01/28/2014] [Indexed: 12/18/2022]
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Nutrition in infants and very young children with chronic kidney disease. Pediatr Nephrol 2012; 27:1427-39. [PMID: 21874586 DOI: 10.1007/s00467-011-1983-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 07/19/2011] [Accepted: 07/20/2011] [Indexed: 12/16/2022]
Abstract
Provision of adequate nutrition is a cornerstone of the management of infants and very young children with chronic kidney disease (CKD). Very young children with CKD frequently have poor spontaneous nutritional intake. Because growth depends strongly on nutrition during early childhood, growth in very young children with CKD is often suboptimal. In this review we will consider the mechanisms and manifestations of inadequate nutritional status in very young children with CKD, mechanisms mediating inadequate nutritional intake, and the optimal nutritional management of this special population. In addition, we suggest an approach to the assessment of nutritional status, including the use of body mass index in infants. Five major nutritional components are considered: energy, macronutrients, fluids and electrolytes, micronutrients, and calcium/phosphorus/vitamin D. The use of adjunctive therapies, including appetite stimulants, treatment of gastroesophageal reflux and gastric dysmotility, enhanced dialytic clearance, and growth hormone, is also briefly discussed.
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Al-Dahhan J, Jannoun L, Haycock GB. 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:F120-3. [PMID: 11882555 PMCID: PMC1721384 DOI: 10.1136/fn.86.2.f120] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The nutritional requirements of prematurely born infants are different from those of babies born at term. Inadequate or inappropriate dietary intake in the neonatal period may have long term adverse consequences on neurodevelopmental function. The late effect of neonatal sodium deficiency or repletion in the premature human infant on neurological development and function has not been examined, despite evidence in animals of a serious adverse effect of salt deprivation on growth of the central nervous system. METHODS Thirty seven of 46 children who had been born prematurely (gestational age of 33 weeks or less) and allocated to diets containing 1-1.5 mmol sodium/day (unsupplemented) or 4-5 mmol sodium/day (supplemented) from the 4th to the 14th postnatal day were recalled at the age of 10-13 years. Detailed studies of neurodevelopmental performance were made, including motor function and assessment of intelligence (IQ), memory and learning, language and executive skills, and behaviour. Sixteen of the children were found to have been in the supplemented group and 21 in the unsupplemented group. RESULTS Children who had been in the supplemented group performed better in all modalities tested than those from the unsupplemented group. The differences were statistically significant (analysis of variance) for motor function, performance IQ, the general memory index, and behaviour as assessed by the children's parents. The supplemented children outperformed the unsupplemented controls by 10% in all three components of the memory and learning tests (difference not significant but p < 0.1 for each) and in language function (p < 0.05 for object naming) and educational attainment (p < 0.05 for arithmetic age). CONCLUSION Infants born at or before 33 weeks gestation require a higher sodium intake in the first two weeks of postnatal life than those born at or near term, and failure to provide such an intake (4-5 mmol/day) may predispose to poor neurodevelopmental outcome in the second decade of life.
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Affiliation(s)
- J Al-Dahhan
- Academic Department of Paediatrics, Guy's, King's and St Thomas' Hospitals School of Medicine, 12th Floor, Guy's Tower, Guy's Hospital, London SE1 9RT, UK
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Parekh RS, Flynn JT, Smoyer WE, Milne JL, Kershaw DB, Bunchman TE, Sedman AB. Improved growth in young children with severe chronic renal insufficiency who use specified nutritional therapy. J Am Soc Nephrol 2001; 12:2418-2426. [PMID: 11675418 DOI: 10.1681/asn.v12112418] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Growth in children with chronic renal failure caused by polyuric, salt-wasting diseases may be hampered if ongoing sodium and water losses are not corrected. Twenty-four children were treated with polyuric chronic renal insufficiency (CRI; creatinine clearance <65 ml/min per 1.73 m(2)) with low-caloric-density, high-volume, sodium-supplemented feedings. Subsequent growth was compared with that of children in two control groups: a national historic population control from the US Renal Data System database (n = 42), and a literature control (n = 12). Members of the three groups were 81 to 96% white, and 58 to 70% were boys. Obstructive uropathy and dysplasia were the cause of CRI in 92% of the treatment group, 75% of the literature control group, and 30% of the population control group. Treatment effect was assessed in a multivariate, retrospective analysis of the height standard deviation score (SDS), simultaneously controlling for the severity of disease by renal replacement therapy, primary cause of CRI, and initial height SDS. The change in SDS (Delta SDS) for height by regression analysis at 1 yr was significantly greater by +1.37 in the treatment group versus the population control (P = 0.017). The 2-yr height Delta SDS by regression analysis adjusted for creatinine clearance was significantly greater by +1.83 in the treatment group versus the literature control (P = 0.003). Nutritional support with sodium and water supplementation can maintain or improve the growth of children with polyuric, salt-wasting CRI. This inexpensive intervention may delay the need for renal replacement therapy, growth hormone treatment, or both in many of these children and may be used in any clinical setting.
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Affiliation(s)
- Rulan S Parekh
- Departments of Pediatrics and Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Joseph T Flynn
- Department of Pediatrics, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - William E Smoyer
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan
| | - Joan L Milne
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan
| | - David B Kershaw
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan
| | | | - Aileen B Sedman
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan
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Kloiber LL, Winn NJ, Shaffer SG, Hassanein RS. Late hyponatremia in very-low-birth-weight infants: incidence and associated risk factors. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1996; 96:880-4. [PMID: 8784332 DOI: 10.1016/s0002-8223(96)00240-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the incidence of late hyponatremia in very-low-birth-weight infants and to identify associated risk factors. Low serum sodium concentration in otherwise healthy premature infants beyond 2 weeks of life is referred to as the hyponatremia. DESIGN Retrospective cohort review. SETTING/SUBJECTS The intensive care nursery at St Luke's Hospital Perinatal Center, Kansas City, Mo. Criteria for subject selection were birth weight of 1,500 g or less; survival for more than 21 days; development of late hyponatremia or hospitalization for 42 days or more; and measurement of serum sodium concentration at least once between the 14th and 56th day of life. Of 515 infants admitted to the nursery for the 1992 calendar year, 124 had a birth weight of 1,500 g or less and survived for more than 21 days; however, 16 of these infants were discharged at 42 days of life or less, 11 did not have a serum sodium concentration measurement after the second week of life, and 1 did not have complete medical records. Thus, the final sample was 96 subjects. STATISTICAL ANALYSES Percentages to determine incidence of late hyponatremia; t test of chi 2 test to determine differences between infants with and without late hyponatremia; multiple logistic regression to determine the strongest indicators of late hyponatremia. RESULTS Incidence of late hyponatremia was 62.5%. Significant risk factors for late hyponatremia were birth weight of 1,000 g or less (P < .001), feedings of fortified human milk (P < .013), and occurrence of an intraventricular hemorrhage (P < .036). Fortified human milk feeding was a significant risk factor for late hyponatremia in both weight groups (ie, birth weight greater than or less than 1,000 g). CONCLUSION Despite standard fortification, human milk may contain an insufficient quantity of sodium to met the needs of very-low-birth-weight infants.
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Affiliation(s)
- L L Kloiber
- Food and Nutrition Department, St Mary of the Plains Hospital, Lubbock, Tex 79410, USA
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