早期补钠对早产儿低钠血症和生长发育的影响

　　美国辛辛那提大学、辛辛那提儿童医院为了验证早产儿住院期间进行早期补钠（早期补钠对早产儿低钠血症和生长发育的影响）可以预防迟发型低钠血症和改善生长发育的假设，开展了一项随机双盲对照研究。

　　该研究对胎龄＜32周早产儿出生后7～35天补充4mEq/kg/d钠（干预组）和无菌水（对照组）进行了比较，主要结局指标为出生后6周体重的增加，次要结局指标包括早产儿出生后住院期间每周血清钠浓度、身长和头围的增加、并发症发生情况。

　　结果共随机入组53例平均胎龄为28.5±2.4周的婴儿，研究期间干预组婴儿血清钠浓度＜135mmol/L发生较少，体重增加速度较快，平均26.9±3.1g/kg/d（比22.9±4.7，P=0.012）。6周时，接受补钠的胎龄＜28周婴儿体重变化较大，平均193%±22%（比173%±10%，P=0.041），与接受安慰剂的婴儿相比，维持胎儿出生参考百分体重较多（P=0.002）。两组身长和头围的增加无显著差异。在补充氯化钠的婴儿中，常见的早产相关并发症发生率亦未增加。

　　因此，早产儿肠内喂养补钠可以防止低钠血症并增加体重。

JPEN J Parenter Enteral Nutr. 2016;40(3):342-9.

Impact of Early Sodium Supplementation on Hyponatremia and Growth in Premature Infants: A Randomized Controlled Trial.

Isemann B, Mueller EW, Narendran V, Akinbi H.

University of Cincinnati Medical Center, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

BACKGROUND: We tested the hypothesis that sodium supplementation in early preterm infants prevents late-onset hyponatremia and improves growth without increasing common morbidities during birth hospitalization.

MATERIALS AND METHODS: This was a randomized, masked controlled trial of 4 mEq/kg/d of sodium (intervention) versus sterile water (placebo) from days-of-life 7 to 35 in infants born at <32 weeks corrected gestational age. The primary outcome was weight gain in the first 6 weeks of life. Secondary outcomes included weekly serum sodium concentrations, growth in body length and head circumference, and complications of prematurity during birth hospitalization.

RESULTS: Fifty-three infants with an average corrected gestational age of 28.5 ± 2.4 weeks were randomized. Infants receiving the intervention had fewer (P = .012) reports of serum sodium concentrations <135 mmol/L and greater velocity of weight gain during the study period, mean (SD) 26.9 (3.1) vs 22.9 (4.7) g/kg/day, P = .012. At 6 weeks of age, infants <28 weeks' gestation who received sodium supplementation had greater percentage weight change from birth, mean (SD) 193% (22%) vs 173% (10%), P = .041, and maintained fetal reference birth percentile for body weight more often (P = .002) compared with infants receiving placebo. Growth in length and head circumference was not significantly different between study arms. No increase in common prematurity-related morbidities was detected in infants who received supplemental sodium chloride.

CONCLUSION: Sodium supplementation of enteral feedings in very premature infants averts hyponatremia and enhances weight gain.

KEYWORDS: anthropometrics; neonates; nutrition

PMID: 25406227

DOI: 10.1177/0148607114558303