Dogra Shivani, Malik Muneer A, Peters Nitin J, Samujh Ram
Department of Pediatric Surgery, Advanced Pediatric Centre, Postgraduate Institute of Medical Education& Research (PGIMER), Chandigarh, 160012 India.
Ann Pediatr Surg. 2022;18(1):72. doi: 10.1186/s43159-022-00197-w. Epub 2022 Sep 21.
During the postoperative course following neonatal surgery, several stimuli like respiratory distress, pain, and stress cause the release of the antidiuretic hormone which can induce hyponatremia. This hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion (SIADH) in neonates can lead to neurologic impairment and in severe cases can cause significant morbidity and mortality. Lung involvement in neonates undergoing TEF makes this subset of patients vulnerable to this entity because most of them are sick and require ventilation in the postoperative period. The incidence of postoperative hyponatremia following neonatal surgery has not been studied vastly. To the best of our knowledge, this is the first prospective study that has analyzed the incidence of postoperative hyponatremia in this vulnerable population.
Prospective observational study to assess the incidence of postoperative hyponatremia in neonates with esophageal atresia and tracheoesophageal fistula (EA and TEF) receiving restricted hypotonic fluids. As per the unit policy N/4 5% D is given in the postoperative period. Most neonatal units follow a protocol in which fluid is hiked daily to reach 150 ml/kg/day in 5-7 days. However, in our neonatal surgical unit a protocol to restrict the maintenance fluid at 100 ml/kg/day irrespective of day of life is followed.
Out of a total of 90 neonates (270 sodium measurements), we identified 16 with hyponatremia (11%). Most of the neonates had mild hyponatremia(130-135 meq/l). The incidence of moderate and severe hyponatremia was low.
Postoperative restriction of fluids especially in neonates who are at a high risk for developing SIADH can lead to decreased incidence of severe hyponatremia.
在新生儿手术后的病程中，呼吸窘迫、疼痛和应激等多种刺激会导致抗利尿激素释放，进而诱发低钠血症。新生儿因抗利尿激素分泌不当综合征（SIADH）所致的低钠血症可导致神经功能损害，严重时可引起显著的发病率和死亡率。接受食管闭锁及气管食管瘘（TEF）手术的新生儿肺部受累，使这部分患者易患该病症，因为他们大多数病情较重，术后需要通气。新生儿手术后低钠血症的发病率尚未得到广泛研究。据我们所知，这是第一项分析这一脆弱人群术后低钠血症发病率的前瞻性研究。
前瞻性观察研究，旨在评估接受限制性低渗液体治疗的食管闭锁和气管食管瘘（EA和TEF）新生儿术后低钠血症的发病率。根据科室政策，术后给予N/4 5%葡萄糖溶液。大多数新生儿科室遵循一种方案，即术后每天增加液体量，在5 - 7天内达到150 ml/kg/天。然而，在我们的新生儿外科科室，遵循的方案是无论出生天数，将维持液量限制在100 ml/kg/天。
在总共90例新生儿（进行了270次血钠测量）中，我们确定了16例低钠血症患者（11%）。大多数新生儿为轻度低钠血症（130 - 135 meq/l）。中度和重度低钠血症的发生率较低。
术后限制液体摄入，尤其是对于发生SIADH风险较高的新生儿，可降低严重低钠血症的发生率。
