Association of early dysnatremia with mortality in the neonatal intensive care unit: results from the AWAKEN study

J Perinatol. 2022 Oct;42(10):1353-1360. doi: 10.1038/s41372-021-01260-x. Epub 2021 Nov 13.

Abstract

Objective: To determine the association of dysnatremia in the first postnatal week and risk of acute kidney injury (AKI) and mortality.

Study design: A secondary analysis of 1979 neonates in the AWAKEN cohort evaluated the association of dysnatremia with (1) AKI in the first postnatal week and (2) mortality, utilizing time-varying Cox proportional hazard models.

Result: Dysnatremia developed in 50.2% of the cohort and was not associated with AKI. Mortality was associated with hyponatremia (HR 2.15, 95% CI 1.07-4.31), hypernatremia (HR 4.23, 95% CI 2.07-8.65), and combined hypo/hypernatremia (HR 6.39, 95% CI 2.01-14.01). In stratified models by AKI-status, hypernatremia and hypo/hypernatremia increased risk of mortality in neonates without AKI.

Conclusion: Dysnatremia within the first postnatal week was associated with increased risk of mortality. Hypernatremia and combined hypo/hypernatremia remained significantly associated with mortality in neonates without AKI. This may reflect fluid strategies kidney injury independent of creatinine and urine-output defined AKI, and/or systemic inflammation.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute Kidney Injury*
  • Creatinine
  • Humans
  • Hypernatremia* / complications
  • Hyponatremia*
  • Infant, Newborn
  • Intensive Care Units, Neonatal
  • Retrospective Studies
  • Risk Factors

Substances

  • Creatinine