Chang Amanda J, York Daniel J, Chen Wenya, Heidenreich Kaeli N, Shah Malika D
Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Department of Neonatology, University of Utah Health, Salt Lake City, Utah.
Pediatr Open Sci. 2025 Apr-Jun;1(2). doi: 10.1542/pedsos.2024-000372. Epub 2025 May 16.
Late preterm and term infants represent the majority of neonatal intensive care unit admissions globally, yet their fluid management remains underexplored.
We conducted a retrospective medical record review of 174 infants 34 weeks' gestational age or older who received dextrose-containing fluids shortly after birth. These infants had 24-hour serum sodium measurements at our institution between April 2018 and April 2021. We used regression models to analyze the correlation among intravenous fluid (IVF) intake per kilogram, gestational age, fluid balance (FB), weight change, and sodium status, adjusting for clinical factors.
At 24 hours, the average IVF intake was 57.2 mL/kg/d (SD 14.9). Of the infants, 130 (75%) had positive FB, 128 (74%) maintained or gained weight, 41 (24%) had sodium levels 132 mEq/L or less, and 68 (39%) had sodium 134 mEq/L or less. Positive FB was associated with weight gain and an increased likelihood of hyponatremia. Regression analysis showed a 0.07-mEq/L decrease in serum sodium (95% CI, -0.09 to -0.05; < .001) for every milliliter per kilogram of positive FB and a 6% increase in the odds of sodium 132 mEq/L or less (95% CI, 1.03-1.08; < .001). Term infants exhibited greater decreases in sodium levels than preterm infants. Infants who did not receive enteral feeds had more pronounced sodium decreases compared with those who were fed.
Positive FB was common and strongly associated with hyponatremia in infants receiving standard IVF rates. These effects were most significant in term and unfed infants. Current fluid strategies may overestimate needs, particularly for term infants not receiving enteral feeds.
晚期早产儿和足月儿占全球新生儿重症监护病房收治患儿的大多数，但他们的液体管理仍未得到充分研究。
我们对174例胎龄34周及以上、出生后不久接受含葡萄糖液体治疗的婴儿进行了回顾性病历审查。这些婴儿于2018年4月至2021年4月在我们机构进行了24小时血清钠测量。我们使用回归模型分析每千克静脉液体（IVF）摄入量、胎龄、液体平衡（FB）、体重变化和钠状态之间的相关性，并对临床因素进行调整。
24小时时，平均IVF摄入量为57.2 mL/kg/d（标准差14.9）。在这些婴儿中，130例（75%）液体平衡为正，128例（74%）体重维持或增加，41例（24%）血清钠水平为132 mEq/L或更低，68例（39%）血清钠为134 mEq/L或更低。液体平衡为正与体重增加和低钠血症可能性增加相关。回归分析显示，每千克每毫升液体平衡为正，血清钠降低0.07 mEq/L（95%CI，-0.09至-0.05；P<.001），血清钠为132 mEq/L或更低的几率增加6%（95%CI，1.03-1.08；P<.001）。足月儿的钠水平下降幅度大于早产儿。未接受肠内喂养的婴儿与接受喂养的婴儿相比，钠水平下降更明显。
在接受标准IVF速率的婴儿中，液体平衡为正很常见，且与低钠血症密切相关。这些影响在足月儿和未喂养婴儿中最为显著。目前的液体策略可能高估了需求，特别是对于未接受肠内喂养的足月儿。
