1. Does Hyponatremia in Asphyxiated Newborn infants correlate with incidence of death or disability?
1Mohamed S. Elboraee, 1,2Ernest Phillipos, 4Leonora Hendson, 1,2,3,6Amber Reichert, 5Xiang Y. Ye, 1,3,6Mosarrat Qureshi
1University of Alberta, Edmonton AB; 2Stollery Children’s Hospital, Edmonton AB; 3Royal Alexandra Hospital, Edmonton AB; 4University of Calgary, Calgary AB; 5Micare research centre, Toronto ON, 6Glenrose Rehabilitation Hospital, Edmonton AB
Background
Results
Figures & Tables
170
HIE (II / III) infants with GA > 35 wk admitted to one of tertiary NICU of Northern Alberta Neonatal Program
167
our study population 72
(43.1%)
infants in Group1 hyponatremia <130mmol/L 9
(5.4%)
infants with Missing data 86
(51.5%)
infants in Group2
sodium ≥130mmol/L 3
major congenital anomaly
Although therapeutic hypothermia (TH) in neonates with moderate or severe hypoxic ischemic encephalopathy (HIE) is a standard component of the neonatal intensive care, hyponatremia has been reported between 33% and 44%, with a trend towards a higher incidence in cooled patients.
Hyponatremia in term newborn infants with HIE has been weakly correlated with death or severe disability at 18 months of age.
It is not, however, clear whether the degree or duration of hyponatremia is correlated with death or severity of disability in these infants.
Of 167 infants, mean GA 39.1±1.6 weeks and mean birth weight 3.354±0.64kg, 57.5% males.
72 (43.1%) infants in Group1 and 86 (51.5%) infants were in Group2 while.
No significant association between Therapeutic Hypothermia and overall sodium (p=0.08).
The incidence of hyponatremia was significantly different between the first hours of age and hours of age(41% Vs 36%,p=0.0138).
Sodium level<130mmol/l was associated with poor outcome both in the univariate and multivariate analysis (p 0.027).
Univariate analysis showed that male infants, infants with Apgar score<5 at 5 min, pH at birth or in first blood
gas <7.0 was significantly associated with the composite outcome of death or disability (p<0.05).
Multivariable analysis, after adjusting for gender, APGAR score<5 at 5 min, overall sodium level and highest Lactate level showed infants in Group 1 had an odds ratio of 2.4 (95%CI 1.19, 4.81) for composite outcome of death or disability (p0.014).
31 (18.5%)
1 (0.5%)
135 (81.0%)
Fig 2. The Outcome of HIE infants
Objectives
To find out the incidence, degree and the duration of hyponatremia, its pathophysiology, correlation with HIE severity, and predictive value in short and long term outcome.
Methods
Data were abstracted for all infants > 35 weeks gestational age (GA) treated in the Northern Alberta Neonatal Program with moderate to severe HIE (HIE II/III) from Jan 1, 2006 to Dec 31, 2012.
Infants with severe growth restriction (<3rd percentile) & major congenital anomalies were excluded.
Primary outcome was a composite of mortality and major disability (cerebral palsy, cognitive delay <2SD below the mean, hearing loss and blindness) up to 3 years of age.
The 2 groups identified were: Gp1= infants with any hyponatremia <130mmol/L during the 1st 96 hours of life, while Gp2= infants with sodium ≥130mmol/L.
Univariate and multivariable regression analyses compared the 2 groups.
Fig 3. The Sodium level in the outcome groups
Fig 4. ROC curve for the hyponatremia
Conclusions
Table 1. Comparison of infant characteristics between Hyponatremia groups
Hyponatremia (Group 1)
Non-Hyponatremia (Group 2)
p-value
Gender (male), %(n/N)
56.94 (41/72 )
55.81 (48/86)
0.89
GA, mean (sd)
39.0 (1.7)
38.6 (1.7)
0.18
Birth weight, mean(sd)
3349 (694)
3325 (586)
0.82
Therapeutic hypothermia,%(n/N)
63.89 (46/72 )
76.47 (65/85)
0.08
Death or Disability up to 3 yrs of age, %(n/N)
44.44 (32/72)
37.2 (32/86)
 0.027
Therapeutic Hypothermia was not observed to be related to the overall sodium levels.
Overall sodium level correlated well with composite outcome of death or disability at 3 years of age.
The incidence of hyponatremia was highest during hours of age. As such careful fluid management during this early stage of treatment should be exercised.
This research has been funded by the WCHRI through the generous support of the Stollery Children's Hospital Foundation