Sodium restriction versus daily maintenance replacement in very low birth weight premature neonates: A randomized, blind therapeutic trial*

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To test the hypothesis that restriction of sodium intake during the first 3 to 5 days of life will prevent the occurrence of hypernatremia and the need for administration of large fluid volumes, we prospectively and randomly assigned 17 babies (mean±SD: 850±120 gm; 27±1 weeks of gestation) to receive in blind fashion either daily maintenance sodium or salt restriction with physician-prescribed parenteral fluid intake. Maintenance-group infants received 3 to 4 mEq of sodium per kilogram per day; restricted infants received no sodium supplement other than with such treatments as transfusion. Sodium balance studies conducted for 5 days demonstrated that maintenance salt intake resulted in a daily sodium balance near zero, whereas sodium-restricted infants continued to excrete urinary sodium at a high rate, which promoted a more negative balance (average dally sodium balance −0.30±1.78 SD in maintenance group vs −3.71±1.47 mEq/kg per day in restriction group; p<0.001). Care givers tended to prescribe daily increases in parenteral fluids for the salt-supplemented infants, perhaps because serum sodium concentrations were elevated in these infants after the first day of the study (p<0.001). Hypernatremia developed in two sodium-supplemented infants (>150 mEq/L), and hyponatremia developed in two sodium-restricted infants (<130 mEq/L); however, the restricted infants were more likely to have normal serum osmolality (p<0.05). Both groups of infants produced urine that was neither concentrated nor dilute, with a high fractional excretion of sodium; renal failure was not observed. The mortality rate was not affected, but the incidence of bronchopulmonary dysplasia was significantly less in the sodium-restricted babies (p<0.02). We conclude that in finy premature infants, a fluid regimen that restricts sodium may simplify parenteral fluid therapy targeted to prevent hypernatremia and excessive administration of parenteral fluids.

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Supported by a Clinical Research Centers grant (No. RR 00240), National Institutes of Health.