Impact of restricting fluid and sodium intake in term asphyxiated newborns treated with hypothermia

Abstract

Aim: To study the consequences of restricting fluid and sodium intake in asphyxiated newborns treated with hypothermia.

Methods: We conducted a retrospective cohort study of asphyxiated newborns treated with hypothermia from 2009 to 2015. The fluid, parenteral nutrition, and sodium, as well as the urine produced per day, were calculated. Sodium and creatinine concentrations were recorded. The presence/severity of brain injury was scored.

Results: Among the 202 newborns, 55% did not have their fluid and sodium intake restricted and 45% had their fluid and sodium intake restricted. Newborns for whom fluid and sodium was restricted had significantly lower sodium concentrations during hospitalization (p = .02) and tended to develop more often a sodium concentration lower than 125 mmol/L (p = .08). They also were more likely to experience worsening in their creatinine levels during hospitalization (p = .03) and developed more often acute kidney injury (p = .02). The incidence of severe brain injury was higher in those newborns (58 versus 43%, p = .12), although not statistically different.

Conclusion: A restrictive strategy for fluid and sodium intake did not appear to be beneficial for asphyxiated newborns treated with hypothermia and might even be harmful.

Keywords:

• Acute kidney injury
• birth asphyxia
• fluid management
• hyponatremia
• neonatal encephalopathy

Acknowledgments

We thank Mr. Wayne Ross Egers for his professional English correction of the manuscript. This manuscript has been contributed to, seen, and approved by all the authors. All the authors fulfill the authorship credit requirements. The authors have no financial relationships relevant to this article to disclose.

Disclosure statement

No potential conflict of interest was reported by the authors. The study sponsors had no involvement in the study design; the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the paper for publication. No honorarium, grant, or other form of payment was received for the preparation of this manuscript.

Additional information

Funding

Pia Wintermark receives research grant funding from the Fonds de Recherche du Quebec – Santé (FRQ-S) Clinical Research Scholar Career Award Junior 2, and a CIHR Open Operating Grant. Michael Zappitelli receives research salary support from the FRQ-S.