Sodium Intake and Intraventricular Hemorrhage in the Preterm Infant

Objective: Hypernatremia is associated with intracranial hemorrhage in term infants. The etiology of intraventricular hemorrhage in preterm infants is multifactorial. We aimed to characterize the associations between sodium intake, hypernatremia, and intraventricular hemorrhage in preterm infants. Methods: The charts of 722 preterm infants with a birth weight <= 1.5kg admitted to a tertiary care neonatal intensive care unit from 2002 to 2006 were retrospectively reviewed for daily sodium and fluid intake, weight loss, serum sodium concentrations, gender, gestational age, pneumothorax, hyper- or hypocarbia, severity of illness, and cranial imaging. A multivariate logistic model was used to adjust for risk factors and determine associations between sodium intake, hypernatremia, and intraventricular hemorrhage. Results: Grade II to IV intraventricular hemorrhage was associated with increased sodium intake on each of the first 3 days following birth. The association remained after controlling for gestational age, severity of illness, respiratory factors, and gender. The association of high sodium intake with intraventricular hemorrhage was of similar magnitude to traditionally recognized risk factors such as pneumothorax. Interpretation: Increasing intake of sodium appears to be a modifiable risk factor for intraventricular hemorrhage in very low birth weight infants. ANN NEUROL 2010;67:817-823