Relationship Between Hypernatremia And Intraventricular Hemorrhage In Very & Extremely Preterm Neonates

Background Intraventricular hemorrhage(IVH)is one of the most common cause of infant morbidity and mortality,mostly associated with preterm births.The incidence of IVH since last decade or so have been significantly reduced,still,IVH is considered a highly significant risk factor for morbidity and mortality among very and extremely preterm neonates.ObjectivesThe objectives of this study were to examine and investigate the association between severe IVH and serum sodium levels or hypernatremia in preterm infants.The specific goals were:1.To investigate whether the fluctuation level of serum sodium in preterm infants will cause or aggravate the intracranial hemorrhage of preterm infants.2.To study the incidence of hypernatremia in preterm infants.MethodologyThe present retrospective study was conducted at t the Neonatal Intensive Care Unit(NICU),Zhongda Hospital Jiangsu Nanjing,China between1 st January 2017 and31 st December 2018.inclusion criteria: 1.Babies with gestational age < 32 weeks;2.hospitalized within 24 hours after birth;3.had at least 3 times of blood gas within 72 hours;4.survived for more than 28 days,and had skull imaging examination within 28 days;5.had complete information was included in the study.The preterm neonates with brain malformations and the infants with congenital anomalies of dysmorphic features which were suggestive of chromosomal abnormalities,metabolic disorders,and genetic syndromes were excluded from the study.The relationship between the hypernatremia and severe IVH was examined by applying ANOVA with Sodium Serum level in preterm neonates as the independent variable while Intraventricular hemorrhage,gender of the preterm neonate as the dependent variables.A pvalue of less than 0.05 was considered statistically significant.Results1.A total of 214 preterm infants 111/214(51.39%)males and 103/214(48.1%)female)were enrolled in the study.2.The incidence of IVH was 38.8%(83 / 214).,out of which 28.0%(60/214)had mild IVH while 10.7%(23/214)had severe IVH.3.It was observed that neonates in the severe IVH category were born much earlier compared to other groups(p=0.001).4.There was a significant negative correlation between hypernatremia and gestational age less than 28 weeks of gestation(p<0.0001).5.We observed that infants with patent ductus arteriosus(PDA)and Bronchopulmonary dysplasia(BPD were more likely to develop severe intraventricular hemorrhage compared to the control and mild IVH group(p=0.001)and(p=0.039).6.The highest sodium level was slightly greater in the mild IVH group,compared with the severe IVH group and No IVH group,however the difference was not statistically significant(p=0.226).7.The fluctuation in serum sodium levels was not significantly different among the groups.Conclusion1.Among other risk factors,PDA and BPD and birth of infant at <28 weeks of gestation are independent risk factors for IVH among preterm infants.2.The study indicates that there was a possible association between IVH and hypernatremia among preterm infants;however,the cause and effect relationship in high sodium level and preterm neonates has remained unclear.3.Further research is necessary to evaluate these relationships between hypernatremia and intraventricular hemorrhage.