Department of Pediatrics, Jeonbuk National University School of Medicine, Jeonju, South Korea.
Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea.
Medicine (Baltimore). 2021 Dec 10;100(49):e28124. doi: 10.1097/MD.0000000000028124.
Neonatologists often experience sodium ion level difference between an arterial blood gas analyzer (direct method) and an autoanalyzer (indirect method) in critically ill neonates. We hypothesize that clinical factors besides albumin and protein in the blood that cause laboratory errors might be associated with sodium ion level difference between the 2 methods in very-low-birth-weight infants during early life after birth. Among very-low-birth-weight infants who were admitted to Jeonbuk National Hospital Neonatal Intensive Care Units from October 2013 to December 2016, 106 neonates were included in this study. Arterial blood sample was collected within an hour after birth. Blood gas analyzer and biochemistry autoanalyzer were performed simultaneously. Seventy-six (71.7%) were found to have sodium ion difference exceeding 4 mmol/L between 2 methods. The mean difference of sodium ion level was 5.9 ± 6.1 mmol/L, exceeding 4 mmol/L. Based on sodium ion level difference, patients were divided into >4 and ≤4 mmol/L groups. The sodium level difference >4 mmol/L group showed significantly (P < .05) higher sodium level by biochemistry autoanalyzer, lower albumin, lower protein, and higher maximum percent of physiological weight than the sodium level difference ≤4 mmol/L group. After adjusting for factors showing significant difference between the 2 groups, protein at birth (odds ratio: 0.835, 95% confidence interval: 0.760-0.918, P < .001) and percent of maximum weight loss (odds ratio: 1.137, 95% confidence interval: 1.021-1.265, P = .019) were factor showing significant associations with sodium level difference >4 mmol/L between 2 methods. Thus, difference in sodium level between blood gas analyzer and biochemistry autoanalyzer in early stages of life could reflect maximum physiology weight loss. Based on this study, if the study to predict the body's composition of extracellular and intracellular fluid is proceeded, it will help neonatologist make clinical decisions at early life of preterm infants.
新生儿科医生在危重新生儿中经常会发现动脉血气分析仪（直接法）和自动分析仪（间接法）之间的钠离子水平差异。我们假设，除了血液中的白蛋白和蛋白质之外，导致实验室误差的其他临床因素可能与极低出生体重儿出生后早期两种方法之间的钠离子水平差异有关。在 2013 年 10 月至 2016 年 12 月期间入住全罗北道国立医院新生儿重症监护病房的极低出生体重儿中，共有 106 名患儿纳入本研究。在出生后 1 小时内采集动脉血样。同时进行血气分析仪和生化自动分析仪检测。结果发现，76 例（71.7%）两种方法的钠离子差值超过 4mmol/L。钠离子水平的平均差值为 5.9±6.1mmol/L，超过 4mmol/L。基于钠离子水平差异，将患者分为>4mmol/L 和≤4mmol/L 两组。钠离子水平差异>4mmol/L 组的生化自动分析仪钠离子水平显著高于（P<0.05），白蛋白、蛋白较低，最大生理体重百分比较高。调整两组间有显著差异的因素后，出生时的蛋白（比值比：0.835，95%置信区间：0.760-0.918，P<0.001）和最大体重减轻百分比（比值比：1.137，95%置信区间：1.021-1.265，P=0.019）是两种方法间钠离子水平差异>4mmol/L 的显著相关因素。因此，生命早期血气分析仪和生化自动分析仪之间钠离子水平的差异可以反映最大生理体重减轻。基于本研究，如果进行预测细胞外液和细胞内液成分的研究，将有助于新生儿科医生在早产儿生命早期做出临床决策。
