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Pediatr Res. 2017 Mar;81(3):455-460. doi: 10.1038/pr.2016.264. Epub 2016 Dec 9.

Sodium supply influences plasma sodium concentration and the risks of hyper- and hyponatremia in extremely preterm infants.

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Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
Department of Food and Nutrition, Umeå University, Umeå, Sweden.
Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden.



Hyper- and hyponatremia occur frequently in extremely preterm infants. Our purpose was to investigate plasma sodium (P-Na) concentrations, the incidence of hyper- and hyponatremia, and the impact of possible predisposing factors in extremely preterm infants.


In this observational study, we analyzed data from the EXtremely PREterm (< 27 wk.) infants in Sweden Study (EXPRESS, n = 707). Detailed nutritional, laboratory, and weight data were collected retrospectively from patient records.


Mean ± SD P-Na increased from 135.5 ± 3.0 at birth to 144.3 ± 6.1 mmol/l at a postnatal age of 3 d and decreased thereafter. Fifty percent of infants had hypernatremia (P-Na > 145 mmol/l) during the first week of life while 79% displayed hyponatremia (P-Na < 135 mmol/l) during week 2. Initially, the main sodium sources were blood products and saline injections/infusions, gradually shifting to parenteral and enteral nutrition towards the end of the first week. The major determinant of P-Na and the risks of hyper- and hyponatremia was sodium supply. Fluid volume provision was associated with postnatal weight change but not with P-Na.


The supply of sodium, rather than fluid volume, is the major factor determining P-Na concentrations and the risks of hyper- and hyponatremia.

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