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Soriano LP, Rollins MD, Barreto Chang OL. Case Report of Hyponatremic Seizures in a Term Neonate Attributed to Excessive Maternal Coconut Water Ingestion During Labor. A A Pract 2024; 18:e01815. [PMID: 38975685 DOI: 10.1213/xaa.0000000000001815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
We report the case of a term neonate who was somnolent at birth with ventilatory distress and experienced 2 seizures shortly after delivery. Laboratory tests revealed the neonate had a serum sodium of 113 mmol/L. The seizures stopped after treatment with midazolam, and the sodium was corrected slowly with 3% hypertonic saline without further sequelae. The severe neonatal hyponatremia and seizures were attributed to maternal consumption of excessive amounts of coconut water during labor. This case demonstrates the importance of careful consideration of both fluid volume and fluid electrolyte composition during labor to prevent adverse maternal and neonatal outcomes.
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Affiliation(s)
- Laura P Soriano
- From the Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California
| | - Mark D Rollins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Odmara L Barreto Chang
- From the Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California
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2
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Li H, Chen X, Chen L, Li J, Liu X, Chen C, Xie D, Yuan J, Tao E. Case report: Acute severe hyponatremia-induced seizures in a newborn: a community-acquired case and literature review. Front Pharmacol 2024; 15:1391024. [PMID: 38957388 PMCID: PMC11218545 DOI: 10.3389/fphar.2024.1391024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 05/28/2024] [Indexed: 07/04/2024] Open
Abstract
Severe neonatal hyponatremia represents a critical electrolyte imbalance with potentially severe neurological outcomes, a condition rarely documented in community-acquired, full-term newborns. This report underscores a unique case of a 23-day-old, previously healthy, full-term male neonate experiencing severe hyponatremia that precipitated seizures, underscoring the urgency of prompt recognition and intervention. The neonate presented with symptoms including vomiting, groaning, chills, fixed staring, and limb tremors. Critical findings upon admission encompassed hypothermia, hypotension, tachycardia, and tachypnea accompanied by significant weight loss. The clinical presentation was marked by dehydration, lethargy, weak crying, a fixed gaze, irregular breathing, and coarse lung sounds, yet a distended abdomen, hypertonic limb movements, and recurrent seizures were observed. Immediate interventions included establishing IV access, rewarming, mechanical ventilation, seizure management, volume expansion, dopamine for circulatory support, and initiation of empirical antibiotics. Diagnostic evaluations revealed a sodium ion concentration of 105.9 mmol/L, while amplitude-integrated electroencephalography (aEEG) detected pronounced seizure activity characterized by a lack of sleep-wake rhythmicity, noticeable elevation in both the lower and upper amplitude margins, and a sustained decrease in the lower margin voltage dropping below 5 μV, presenting as sharp or serrated waveforms. The management strategy entailed rapid electrolyte normalization using hypertonic saline and sodium bicarbonate, anticonvulsant therapy, and comprehensive supportive care, with continuous aEEG monitoring until the cessation of seizures. Remarkably, by the third day, the neonate's condition had stabilized, allowing for discharge in good health 10 days post-admission. At a 16-month follow-up, the child exhibited no adverse neurological outcomes and demonstrated favorable growth and development. Our extensive review on the etiology, clinical manifestations, aEEG monitoring, characteristics of seizures induced by severe neonatal hyponatremia, treatment approaches, and the prognosis for seizures triggered by severe hyponatremia aims to deepen the understanding and enhance clinical management of this complex condition. It stresses the importance of early detection, accurate diagnosis, and customized treatment protocols to improve outcomes for affected neonates. Additionally, this review accentuates the indispensable role of aEEG monitoring in managing neonates at elevated risk for seizures. Yet, the safety and efficacy of swiftly administering hypertonic saline for correcting severe hyponatremia-induced seizures necessitate further investigation through medical research.
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Affiliation(s)
- Haiting Li
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Xiyang Chen
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Linlin Chen
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Jie Li
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Xixi Liu
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Caie Chen
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Dengpan Xie
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Junhui Yuan
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
| | - Enfu Tao
- Department of Neonatology and NICU, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang Province, China
- Department of Science and Education, Wenling Maternal and Child Healthcare Hospital, Wenling, Zhejiang Province, China
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3
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Bardanzellu F, Marcialis MA, Frassetto R, Melis A, Fanos V. Differential diagnosis between syndrome of inappropriate antidiuretic hormone secretion and cerebral/renal salt wasting syndrome in children over 1 year: proposal for a simple algorithm. Pediatr Nephrol 2022; 37:1469-1478. [PMID: 34468821 PMCID: PMC9192468 DOI: 10.1007/s00467-021-05250-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/28/2021] [Accepted: 07/15/2021] [Indexed: 11/24/2022]
Abstract
Hyponatremia, especially if acute and severe, can be a life-threatening condition. Several conditions can trigger hyponatremia. In this review, we will discuss two conditions that can determine euvolemic hyponatremia: the cerebral/renal salt wasting (CRSW) syndrome and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), including the two subtypes: reset osmostat (RO) and nephrogenic syndrome of inappropriate antidiuresis (NSIAD) and their differential diagnoses. Despite the passage of over 70 years since its first description, to date, the true etiopathogenesis of CRSW syndrome, a rare cause of hypovolemic/euvolemic hyponatremia, is almost unknown. SIADH, including RO and NSIAD, is sometimes difficult to differentiate from CRSW syndrome; in its differential diagnosis, the clinical approach based on the evaluation of the extracellular volume (ECV) was proven insufficient. We therefore suggest a simple diagnostic algorithm based on the assessment of the degree of hyponatremia, urinary osmolality, and the assessment of the fraction of urate excretion (FEUa) in conditions of hyponatremia and after serum sodium correction, to be applied in children over 1 year of life.
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Affiliation(s)
- Flaminia Bardanzellu
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari, SS 554 km 4, 500, 09042, Monserrato, Italy.
| | - Maria Antonietta Marcialis
- grid.7763.50000 0004 1755 3242Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari, SS 554 km 4, 500, 09042 Monserrato, Italy
| | - Roberta Frassetto
- grid.7763.50000 0004 1755 3242Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari, SS 554 km 4, 500, 09042 Monserrato, Italy
| | - Alice Melis
- grid.7763.50000 0004 1755 3242Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari, SS 554 km 4, 500, 09042 Monserrato, Italy
| | - Vassilios Fanos
- grid.7763.50000 0004 1755 3242Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari, SS 554 km 4, 500, 09042 Monserrato, Italy
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Kim HH, Kim JK. Clinical factors within a week of birth influencing sodium level difference between an arterial blood gas analyzer and an autoanalyzer in VLBWIs: A retrospective study. Medicine (Baltimore) 2021; 100:e28124. [PMID: 34889274 PMCID: PMC8663822 DOI: 10.1097/md.0000000000028124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 11/12/2021] [Indexed: 01/05/2023] Open
Abstract
Neonatologists often experience sodium ion level difference between an arterial blood gas analyzer (direct method) and an autoanalyzer (indirect method) in critically ill neonates. We hypothesize that clinical factors besides albumin and protein in the blood that cause laboratory errors might be associated with sodium ion level difference between the 2 methods in very-low-birth-weight infants during early life after birth. Among very-low-birth-weight infants who were admitted to Jeonbuk National Hospital Neonatal Intensive Care Units from October 2013 to December 2016, 106 neonates were included in this study. Arterial blood sample was collected within an hour after birth. Blood gas analyzer and biochemistry autoanalyzer were performed simultaneously. Seventy-six (71.7%) were found to have sodium ion difference exceeding 4 mmol/L between 2 methods. The mean difference of sodium ion level was 5.9 ± 6.1 mmol/L, exceeding 4 mmol/L. Based on sodium ion level difference, patients were divided into >4 and ≤4 mmol/L groups. The sodium level difference >4 mmol/L group showed significantly (P < .05) higher sodium level by biochemistry autoanalyzer, lower albumin, lower protein, and higher maximum percent of physiological weight than the sodium level difference ≤4 mmol/L group. After adjusting for factors showing significant difference between the 2 groups, protein at birth (odds ratio: 0.835, 95% confidence interval: 0.760-0.918, P < .001) and percent of maximum weight loss (odds ratio: 1.137, 95% confidence interval: 1.021-1.265, P = .019) were factor showing significant associations with sodium level difference >4 mmol/L between 2 methods. Thus, difference in sodium level between blood gas analyzer and biochemistry autoanalyzer in early stages of life could reflect maximum physiology weight loss. Based on this study, if the study to predict the body's composition of extracellular and intracellular fluid is proceeded, it will help neonatologist make clinical decisions at early life of preterm infants.
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Affiliation(s)
- Hyun Ho Kim
- Department of Pediatrics, Jeonbuk National University School of Medicine, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Jin Kyu Kim
- Department of Pediatrics, Jeonbuk National University School of Medicine, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
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5
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Hossain Z, Qasem WA, Friel JK, Omri A. Effects of Total Enteral Nutrition on Early Growth, Immunity, and Neuronal Development of Preterm Infants. Nutrients 2021; 13:2755. [PMID: 34444915 PMCID: PMC8401306 DOI: 10.3390/nu13082755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 11/16/2022] Open
Abstract
The feeding of colostrum and mother's transitional milk improves immune protection and neurodevelopmental outcomes. It also helps with gut maturation and decreases the risks of infection. The supply of nutrients from human milk (HM) is not adequate for preterm infants, even though preterm mother's milk contains higher concentrations of protein, sodium, zinc, and calcium than mature HM. The human milk fortifiers, particularly those with protein, calcium, and phosphate, should be used to supplement HM to meet the necessities of preterm infants. The management of fluid and electrolytes is a challenging aspect of neonatal care of preterm infants. Trace minerals such as iron, zinc, copper, iodine, manganese, molybdenum, selenium, chromium, and fluoride are considered essential for preterm infants. Vitamins such as A, D, E, and K play an important role in the prevention of morbidities, such as bronchopulmonary dysplasia, retinopathy of prematurity, and intraventricular hemorrhage. Therefore, supplementation of HM with required nutrients is recommended for all preterm infants.
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Affiliation(s)
- Zakir Hossain
- Department of Fisheries Biology and Genetics, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Wafaa A Qasem
- Department of Surgery, Mubarak AlKabeer Hospital, Hawally 32052, Kuwait;
- Community Medicine Department, Faculty of Medicine, Kuwait University, Kuwait City 13003, Kuwait
| | - James K. Friel
- Richardson Centre for Functional Foods and Nutraceuticals, Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, MB R3T 6C5, Canada;
| | - Abdelwahab Omri
- The Novel Drug and Vaccine Delivery Systems Facility, Department of Chemistry and Biochemistry, Laurentian University, Sudbury, ON P3E 2C6, Canada;
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Baczynski M, Kelly E, McNamara PJ, Shah PS, Jain A. Short and long-term outcomes of chronic pulmonary hypertension in preterm infants managed using a standardized algorithm. Pediatr Pulmonol 2021; 56:1155-1164. [PMID: 33270376 DOI: 10.1002/ppul.25200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is limited data on management strategies for chronic pulmonary hypertension (cPH) in chronic lung disease (CLD) of prematurity. Our objective was to evaluate clinical outcomes following a standardized policy, wherein only cPH with right-ventricular (RV) dilatation was treated and diuretics were employed as first-line therapy; cPH without RV-dilatation was managed expectantly. METHOD In this retrospective cohort study, all infants with CLD were categorized as "CLD-only" or "CLD-cPH," using echocardiography at ≥36 weeks postmenstrual age. Intergroup comparison was performed. Regression analysis examined the association between cPH and primary outcome of death or disability at 18-24 months. RESULTS Of 128 CLD infants, 48 (38%) had cPH, of which 29 (60%) received diuretics. Symptomatic improvement within 1-week was recorded in 90%. Although CLD-cPH had worse in-hospital respiratory course than CLD-only, all post-discharge respiratory and neurodevelopmental outcomes were similar. cPH was not associated with death or disability (adjusted odds ratio, 1.02; 95% confidence interval, 0.32-3.27). Disease progression treated with sildenafil occurred in 2 (4%) cases. There was no death from respiratory or RV failure. CONCLUSION Primary treatment of CLD-cPH with diuretics using RV-dilatation as therapeutic threshold, may result in symptomatic improvement, disease stabilization and post-discharge outcomes comparable to infants without cPH.
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Affiliation(s)
- Michelle Baczynski
- Department of Respiratory Therapy, Mount Sinai Hospital, Toronto, Canada
| | - Edmond Kelly
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada
| | - Patrick J McNamara
- Division of Neonatology, University of Iowa Stead Family Children's Hospital, Iowa, USA
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada.,Lunnenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Amish Jain
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada.,Lunnenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada.,Department of Physiology, University of Toronto, Toronto, Canada
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Hernández López AB, Muriel Miguel C, Fernández-Cañadas Morillo A, López Lapeyrere C, Pérez Medina T, Salcedo Mariña Á, Fornet Ruiz I, Rubio González E, Solís Muñoz M. Efficacy of "optimal hydration" during labor: HYDRATA study protocol for a randomized clinical trial. Res Nurs Health 2019; 43:8-16. [PMID: 31793019 DOI: 10.1002/nur.21998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/13/2019] [Indexed: 12/23/2022]
Abstract
There is a lack of consensus in the international scientific community with respect to the most suitable hydration strategies when attending nulliparous women during low-risk births. This paper describes the protocol for a randomized controlled trial to compare two hydration strategies and their influence on maternal and neonatal morbidity. The study population consists of nulliparous women admitted to the obstetrics department of a University Hospital. The women are being randomized into two groups: the "optimal hydration" group, which will be guaranteed 300 ml/hr liquids (crystalloids and bottled mineral water) with a minimum diuresis of 35 ml/hr; and the "variability in hydration" group, which will receive intravenous (alternating normal saline, Ringer's lactate solution, glucose, or Voluven®) and clear (bottled mineral water or isotonic drinks [Aquarius®]) liquids, without any established perfusion rate, and without established minimum diuresis. Outcomes for mothers include duration of labor, cesarean section, fever, and dehydration. Outcomes for newborns are respiratory distress, hypoglycemia, hyponatremia, jaundice, weight loss over 48 hr, and breastfeeding difficulties. Analysis will be per-protocol. Administering optimal hydration may improve health and safety for mothers and their newborn and reduce maternal and neonatal morbidity. The study is registered at www.clinicaltrials.gov. The project received funding by the Ministry of Health of Spain and is approved by the Research Ethics Committee.
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Affiliation(s)
- Ana Belén Hernández López
- Departamento de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España.,Grupo de Investigación en Enfermería y Salud, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, España
| | - Cristina Muriel Miguel
- Departamento de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España
| | - Aurora Fernández-Cañadas Morillo
- Departamento de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España.,Grupo de Investigación en Enfermería y Salud, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, España
| | - Carolina López Lapeyrere
- Grupo de Investigación en Enfermería y Salud, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, España.,Centro de Salud Valle de la Oliva, Madrid, España
| | - Tirso Pérez Medina
- Departamento de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España.,Escuela de medicina, Universidad Autonoma de Madrid, Madrid, España.,Grupo de Investigación y Desarrollo de Nuevas Técnicas Quirúrgicas en Ginecología, Puerta de Hierro- Instituto de Investigación Sanitaria Segovia Arana, Madrid, España
| | - Ángel Salcedo Mariña
- Departamento de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España
| | - Inocencia Fornet Ruiz
- Departamento de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España
| | - Esther Rubio González
- Departamento de nefrología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España
| | - Montserrat Solís Muñoz
- Grupo de Investigación en Enfermería y Salud, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, España.,Unidad de Investigación de Cuidados, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España
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Obi M, Onwuzulike K. Neonatal Hyponatremia in the Setting of Untreated Progressive Hydrocephalus. World Neurosurg 2019; 125:19-22. [PMID: 30716495 DOI: 10.1016/j.wneu.2019.01.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hyponatremia in the neonatal population is an uncommon occurrence and can be associated with significant increase in morbidity and mortality. In the neonatal population, it is typically associated with an excess of antidiuretic hormone and rarely has been found to be associated with hydrocephalus, short of being caused by the subsequent treatment of hydrocephalus. CASE DESCRIPTION We present a case report of a patient with neonatal hydrocephalus, secondary to intraventricular hemorrhage in the setting of prematurity, treated at our institution, in whom sodium levels reached a nadir as head circumference peaked and subsequent treatment of hydrocephalus resolved the associated hyponatremia. CONCLUSIONS Hydrocephalus secondary to intraventricular hemorrhage is a notable complication in the premature neonatal population. Physicians should be aware of its potential association with hyponatremia and consider early neurosurgical intervention when other etiologies of the electrolyte disturbance cannot be identified.
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Affiliation(s)
- Megan Obi
- Case Western Reserve School of Medicine, Cleveland, Ohio, USA
| | - Kaine Onwuzulike
- Department of Pediatric Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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Ahn JG, Lee JE, Chung WY, Koo SH, Shin J, Jeon GW. A Rare Case of Hyponatremia Caused by Reset Osmostat in a Neonate with Cleft Lip, Cleft Palate, and Imperforate Anus. NEONATAL MEDICINE 2018. [DOI: 10.5385/nm.2018.25.3.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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10
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Gökce IK, Turgut H, Ozdemir R, Onal SC. Development of severe hyponatremia due to cerebrospinal fluid leakage following meningomyelocele surgery in a newborn. J Neurosurg Pediatr 2018. [PMID: 29521607 DOI: 10.3171/2017.11.peds17386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cerebrospinal fluid leakage following meningomyelocele surgery is a frequent complication in the wound-healing period and is associated with wound dehiscence. CSF loss can cause severe hyponatremia, especially in the newborn and early infancy periods when dietary sodium content is relatively low. Hyponatremia in the newborn period can result in adverse neurodevelopmental outcomes. In addition, hyponatremia's cerebral effects can increase complications in neurosurgery patients. The authors present the case of a newborn in whom CSF leakage from the operative site and severe hyponatremia developed following meningomyelocele surgery. To the best of their knowledge, severe hyponatremia caused by CSF leakage after meningomyelocele surgery has not been previously reported in the literature.
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Affiliation(s)
| | - Hatice Turgut
- 1Department of Pediatrics, Division of Neonatology, and
| | | | - Selami Cagatay Onal
- 2Department of Neurosurgery, Inonu University School of Medicine, Turgut Ozal Medical Center, Battalgazi, Malatya, Turkey
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11
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Hong CR, Fullerton BS, Mercier CE, Morrow KA, Edwards EM, Ferrelli KR, Soll RF, Modi BP, Horbar JD, Jaksic T. Growth morbidity in extremely low birth weight survivors of necrotizing enterocolitis at discharge and two-year follow-up. J Pediatr Surg 2018; 53:1197-1202. [PMID: 29627178 DOI: 10.1016/j.jpedsurg.2018.02.085] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/27/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this study was to examine postnatal growth outcomes and predictors of growth failure at 18-24months corrected age among extremely low birth weight (ELBW) survivors of necrotizing enterocolitis (NEC) compared to survivors without NEC. METHODS Data were collected prospectively on ELBW (22-27weeks gestation or 401-1000g birth weight) infants born 2000-2013 at 46 centers participating in the Vermont Oxford Network follow-up project. Severe growth failure was defined as <3rd percentile weight-for-age. RESULTS There were 9171 evaluated infants without NEC, 416 with medical NEC, and 462 with surgical NEC. Rates of severe growth failure at discharge were higher among infants with medical NEC (56%) and surgical NEC (61%), compared to those without NEC (36%). At 18-24months follow-up, rates of severe growth failure decreased and were similar between without NEC (24%), medical NEC (24%), and surgical NEC (28%). On multivariable analysis, small for gestational age, chronic lung disease, severe intraventricular hemorrhage or cystic periventricular leukomalacia, severe growth failure at discharge, and postdischarge tube feeding predicted <3rd percentile weight-for-age at follow-up. CONCLUSIONS ELBW survivors of NEC have higher rates of severe growth failure at discharge. While NEC is not associated with severe growth failure at follow-up, one quarter of ELBW infants have severe growth failure at 18-24months. TYPE OF STUDY Prognosis study. LEVEL OF EVIDENCE II.
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MESH Headings
- Enteral Nutrition
- Enterocolitis, Necrotizing/complications
- Enterocolitis, Necrotizing/physiopathology
- Enterocolitis, Necrotizing/therapy
- Female
- Follow-Up Studies
- Growth Disorders/etiology
- Humans
- Infant
- Infant, Extremely Low Birth Weight
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/physiopathology
- Infant, Premature, Diseases/therapy
- Male
- Patient Discharge
- Survivors
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Affiliation(s)
- Charles R Hong
- Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Brenna S Fullerton
- Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Charles E Mercier
- University of Vermont, 89 Beaumont Avenue, Burlington, VT 05405, USA
| | - Kate A Morrow
- Vermont Oxford Network, 33 Kilburn Street, Burlington, VT 05401, USA
| | - Erika M Edwards
- University of Vermont, 89 Beaumont Avenue, Burlington, VT 05405, USA; Vermont Oxford Network, 33 Kilburn Street, Burlington, VT 05401, USA
| | - Karla R Ferrelli
- Vermont Oxford Network, 33 Kilburn Street, Burlington, VT 05401, USA
| | - Roger F Soll
- University of Vermont, 89 Beaumont Avenue, Burlington, VT 05405, USA; Vermont Oxford Network, 33 Kilburn Street, Burlington, VT 05401, USA
| | - Biren P Modi
- Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Jeffrey D Horbar
- University of Vermont, 89 Beaumont Avenue, Burlington, VT 05405, USA; Vermont Oxford Network, 33 Kilburn Street, Burlington, VT 05401, USA
| | - Tom Jaksic
- Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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13
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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.
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England A, Wade K, Smith PB, Berezny K, Laughon M. Optimizing operational efficiencies in early phase trials: The Pediatric Trials Network experience. Contemp Clin Trials 2016; 47:376-82. [PMID: 26968616 PMCID: PMC4997801 DOI: 10.1016/j.cct.2016.03.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 01/09/2023]
Abstract
Performing drug trials in pediatrics is challenging. In support of the Best Pharmaceuticals for Children Act, the Eunice Kennedy Shriver National Institute of Child Health and Human Development funded the formation of the Pediatric Trials Network (PTN) in 2010. Since its inception, the PTN has developed strategies to increase both efficiency and safety of pediatric drug trials. Through use of innovative techniques such as sparse and scavenged blood sampling as well as opportunistic study design, participation in trials has grown. The PTN has also strived to improve consistency of adverse event reporting in neonatal drug trials through the development of a standardized adverse event table. We review how the PTN is optimizing operational efficiencies in pediatric drug trials to increase the safety of drugs in children.
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Affiliation(s)
- Amanda England
- Division of Neonatal-Perinatal Medicine, The University of North Carolina at Chapel Hill, N.C. Memorial Hospital, 101 Manning Drive, CB#7596, Chapel Hill, NC 27599-7596, USA
| | - Kelly Wade
- Division of Neonatology, Children's Hospital of Pennsylvania, CHOP Newborn Care at the Hospital of the University of Pennsylvania, 800 Spruce St., Philadelphia, PA 19107, USA
| | - P Brian Smith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC 27710, USA; Duke Clinical Research Institute, Duke University School of Medicine, P.O. Box 17969, Durham, NC 27715, USA
| | - Katherine Berezny
- Duke Clinical Research Institute, Duke University School of Medicine, P.O. Box 17969, Durham, NC 27715, USA
| | - Matthew Laughon
- Division of Neonatal-Perinatal Medicine, The University of North Carolina at Chapel Hill, N.C. Memorial Hospital, 101 Manning Drive, CB#7596, Chapel Hill, NC 27599-7596, USA.
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Valerio E, Fantinato M, Giovannini IAB, Baraldi E, Chiandetti L. Severe asymptomatic maternal antepartum hyponatremia leading to neonatal seizures: prevention is better than cure. Matern Health Neonatol Perinatol 2015; 1:25. [PMID: 27057342 PMCID: PMC4823737 DOI: 10.1186/s40748-015-0027-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/03/2015] [Indexed: 11/24/2022] Open
Abstract
Background Pre-delivery maternal electrolyte derangements may reflect themselves in the newborn, since placental homeostasis determines electrolyte equilibrium between mother and fetus. Case presentation A term newborn, transferred to our Neonatal Intensive Care Unit 1 h after birth for an apnoea episode, presented with initially left-sided, and subsequently generalized tonic-clonic seizures due to severe hyponatremia (119 mmol/L). Seizures rapidly ceased after electrolyte correction plus a phenobarbital bolus. Deep hyponatremia was also detected in the mother (123 mmol/L). Conclusions As placental homeostasis determines electrolytes equilibrium between mother and fetus, obstetrics and neonatologists should be aware that any maternal dyselectrolytemia will reflect itself in the newborn; hence, it is fundamental to detect possible maternal electrolyte imbalances before delivery, in order to be prepared to timely correction of electrolyte derangements in the newborn.
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Affiliation(s)
- Enrico Valerio
- Department of Woman and Child Health, Medical School, University of Padua, Via Giustiniani, 3, 35128 Padova, Italy
| | - Margherita Fantinato
- Department of Woman and Child Health, Medical School, University of Padua, Via Giustiniani, 3, 35128 Padova, Italy
| | | | - Eugenio Baraldi
- Department of Woman and Child Health, Medical School, University of Padua, Via Giustiniani, 3, 35128 Padova, Italy
| | - Lino Chiandetti
- Department of Woman and Child Health, Medical School, University of Padua, Via Giustiniani, 3, 35128 Padova, Italy
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Ramel SE, Brown LD, Georgieff MK. The Impact of Neonatal Illness on Nutritional Requirements-One Size Does Not Fit All. CURRENT PEDIATRICS REPORTS 2014; 2:248-254. [PMID: 25722954 PMCID: PMC4337785 DOI: 10.1007/s40124-014-0059-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Sick neonates are at high risk for growth failure and poorer neurodevelopment than their healthy counterparts. The etiology of postnatal growth failure in sick infants is likely multi-factorial and includes undernutrition due to the difficulty of feeding them during their illness and instability. Illness also itself induces fundamental changes in cellular metabolism that appear to significantly alter nutritional demand and nutrient handling. Inflammation and physiologic stress play a large role in inducing the catabolic state characteristic of the critically ill newborn infant. Inflammatory and stress responses are critical short-term adaptations to promote survival, but are not conducive to promoting long-term growth and development. Conditions such as sepsis, surgery, necrotizing enterocolitis, chronic lung disease and intrauterine growth restriction and their treatments are characterized by altered energy, protein and micronutrient metabolism that result in nutritional requirements that are different from those of the healthy, growing term or preterm infant.
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Affiliation(s)
- Sara E. Ramel
- Assistant Professor of Pediatrics, University of Minnesota
Children’s Hospital, 2450 Riverside Avenue; MB630 East Building,
Minneapolis, MN 55454, Ph: 612-626-0644; Fax: 612-624-8176
| | - Laura D. Brown
- Associate Professor of Pediatrics, University of Colorado School of
Medicine, Aurora, CO, Ph: 303-724-0106 Fax: 303-724-0898
| | - Michael K. Georgieff
- Professor of Pediatrics and Child Psychology, University of
Minnesota Children’s Hospital, 2450 Riverside Avenue; MB630 East
Building, Minneapolis, MN 55454, Ph: 612-626-0644; Fax: 612-624-8176
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