Does parenteral nutrition influence electrolyte and fluid balance in preterm infants in the first days after birth?
BACKGROUND
New national guidelines recommend more restricted fluid intake and early initiation of total parenteral nutrition (TPN) in very preterm infants. The aim was study the effect of these guidelines on serum sodium and potassium levels and fluid balance in the first three days after birth.


METHODS
Two cohorts of infants <28 weeks gestational age, born at the Leiden University Medical Center in the Netherlands, were compared retrospectively before (2002-2004, late-TPN) and after (2006-2007, early-TPN) introduction of the new Dutch guideline. Outcome measures were serum sodium and potassium levels, diuresis, and changes in body weight in the first three postnatal days.


RESULTS
In the first three postnatal days no differences between late-TPN (N = 70) and early-TPN cohort (N = 73) in mean (SD) serum sodium (141.1 (3.8) vs 141.0 (3.7) mmol/l) or potassium (4.3 (0.5) vs 4.3 (0.5) mmol/l) were found, but in the early-TPN cohort diuresis (4.5 (1.6) vs 3.2 (1.4) ml/kg/h) and loss of body weight were decreased (-6.0% (7.7) vs -0.8% (8.0)).


CONCLUSIONS
Initiation of TPN immediately after birth and restricted fluid intake in very preterm infants do not seem to influence serum sodium and potassium levels in first three postnatal days. Further research is needed to see if a decreased diuresis and loss of body weight in the first days is the result of a delayed postnatal adaptation or better energy balance.
Elstgeest
Liset E
LE
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
Martens
Shirley E
SE
Lopriore
Enrico
E
Walther
Frans J
FJ
te Pas
Arjan B
AB
D001724:Birth Weight; D001835:Body Weight / Q000502:physiology; D015331:Cohort Studies; D004231:Diuresis / Q000502:physiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood / Q000502:physiology*; D008297:Male; D009426:Netherlands; D010288:Parenteral Nutrition / Q000379:methods* / Q000592:standards; D011188:Potassium / Q000097:blood; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood; D013997:Time Factors; D014882:Water-Electrolyte Balance / Q000502:physiology*
D012964:Sodium; D011188:Potassium