ELBW infants receive inadvertent sodium load above the recommended intake



To determine total sodium load, including inadvertent load, during the first 2 postnatal weeks, and its influence on serum sodium, morbidity, and mortality in extremely low birth weight (ELBW, birth weight <1000 g) infants and to calculate sodium replacement models.


Retrospective data analysis on ELBW infants with a gestational age <28 + 0/7 weeks.


Ninety patients with a median birth weight of 718 g and a median gestational age of 24 + 6/7 weeks were included. Median sodium intake during the first 2 postnatal weeks was 10.2 mmol/kg/day, which was significantly higher than recommended (2–5 mmol/kg/day). Sodium intake did not affect the risk for hypernatremia. Each mmol of sodium intake during the first postnatal week was associated with an increased risk of bronchopulmonary dysplasia (45%) and higher-grade intraventricular hemorrhage (31%), during the second postnatal week for necrotizing enterocolitis (19%), and during both postnatal weeks of mortality (13%). Calculations of two sodium replacement models resulted in a decrease in sodium intake during the first postnatal week of 3.2 and 4.0 mmol/kg/day, respectively.


Sodium load during the first 2 postnatal weeks of ELBW infants was significantly higher than recommended owing to inadvertent sodium intake and was associated with a higher risk of subsequent morbidity and mortality, although the study design does not allow conclusions on causality. Replacement of 0.9% saline with alternative carrier solutions might reduce sodium intake.


  • Sodium intake in ELBW infants during the first 2 postnatal weeks was twofold to threefold higher than recommended; this was mainly caused by inadvertent sodium components.

  • High sodium intake is not related to severe hypernatremia but might be associated with a higher morbidity in terms of BPD, IVH, and NEC.

  • Inadvertent sodium load can be reduced by replacing high sodium-containing carrier solutions with high levels of sodium with alternative hypotonic and/or balanced fluids, model based.

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Investigation, F.E., G.L.-W. (pharmacology); writing, F.E., original draft preparation F.E.; visualization, F.E., R.R.; software, F.E.; conceptualization, N.H., F.E.; methodology, N.H., G.L.-W. (pharmacology); resources, N.H.; data curation, N.H., M.T.; statistics, R.R.; writing, review, and editing, B.J., S.E., G.L.-W. (pharmacology); supervision, A.B.; project administration, F.E.

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Correspondence to Nadja Haiden.

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Eibensteiner, F., Laml-Wallner, G., Thanhaeuser, M. et al. ELBW infants receive inadvertent sodium load above the recommended intake. Pediatr Res (2020). https://doi.org/10.1038/s41390-020-0867-9

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