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Kidney Week

Abstract: FR-PO1090

Incidence of Early Dysnatremia in the Assessment of Neonatal Acute Kidney and Epidemiology (AWAKEN) Cohort

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Basalely, Abby Miriam, The Children''s Hospital at Montefiore, Bronx, New York, United States
  • Askenazi, David J., University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Charlton, Jennifer R., University of Virginia, Charlottesville, Virginia, United States
  • Fuloria, Mamta, The Children''s Hospital at Montefiore, Bronx, New York, United States
  • Guillet, Ronnie, University of Rochester, Rochester, New York, United States
  • Kaskel, Frederick J., Children’s Hospital at Montefiore, Bronx, New York, United States
  • Li, Linzi, University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Selewski, David T., Medical University of South Carolina, Mount Pleasant, South Carolina, United States
  • Reidy, Kimberly J., Children's Hospital at Montefiore/ Albert Einstein College of Medicine, Bronxville, New York, United States
Background

Incidence of dysnatremia during the first postnatal week in the neonatal intensive care unit (NICU) and its association with mortality has not been well described. We hypothesized that incidence of dysnatremia would vary with gestational age (GA) and that early dysnatremia predicts mortality.

Methods

We studied neonates in the AWAKEN cohort, a 24-center retrospective study of NICU admissions on IV fluids ≥ 48 hrs, with ≥ 1 serum sodium (sNA) recording during postnatal days 2-7. sNA values were compared in 3 GA cohorts (24-<29 weeks(wk), ≥29-<36wk, ≥36wk). Hypernatremia was defined as sNa >145meq/L (moderate=146-155, severe=≥156); hyponatremia was defined as sNa <135meq/mL (mild=130-134; moderate=125-129; severe<125). Survival was considered reaching 36 wk post-GA or hospital discharge. Kruskal Wallis, Chi2 tests, and multivariable logistic regression were used as appropriate.

Results

The cohort included 1,972 infants with 15,302 sNa values (Table 1). Of these, 23% developed hypernatremia and 35% developed hyponatremia. The incidence and severity of hypernatremia differed by GA (Figure 1). Infants <29 wk GA were most likely to develop severe hypernatremia (OR 8.8 95%CI 6.1-12.6, p<0.01). The incidence and severity of hyponatremia also differed across GA groups (Figure 2). Over 40% of infants in the 24-<29 wk and ≥36 wk cohorts developed hyponatremia, compared to 26.8% of the ≥29-<36 wk group (p< 0.001). Both hyponatremia (adjusted (a)OR 2.7 95%CI 1.6-4.5, p<0.001) and hypernatremia (aOR 2.2 95%CI 1.3-3.8, p=0.005) in models adjusted for GA predicted increased odds of mortality.

Conclusion

This is the largest and most inclusive cohort to describe the incidence and impact of dysnatremias in critically ill neonates. The incidence and severity of hypernatremia differed by GA category and was most substantial in very premature infants. However, infants 24-<29 wk and ≥36 wk GA developed hyponatremia at similar rates, which may reflect oliguria and/or fluid provision strategies. Further evaluations of this cohort will evaluate whether hyponatremia and hypernatremia are independently associated with mortality after adjusting for other important cofounders.

Funding

  • NIDDK Support