Enteral water for hypernatremia and intestinal morbidity in infants less than or equal to 1000 g birth weight

Abstract

Objective: To evaluate the relationship between enteral water infusion for hypernatremia and significant intestinal morbidity in infants ≤1000 grams. Study design: This is a retrospective study of 321 infants ≤1000 g birth weight. Infants were grouped by the highest serum sodium (mmol/l) during the first 14 days of life as follows: ≥150 (normal control), ≥150 (high sodium control), ≥150 and treated with sterile water (study group). Significant intestinal morbidity was defined as probable or proven necrotizing enterocolitis or spontaneous intestinal perforation. Statistical analysis included Student's t test for continuous variables and χ2 with Yeats correction for frequency variables. Multivariate logistic regression analysis was then performed to evaluate confounding variables among groups. Results: The incidence of intestinal morbidity was significantly higher in the high sodium-water treated group compared to each of the other groups (13/33 (38%) for high sodium-water versus 16/100 (16%) for high sodium control and 18/188 (10%) for normal sodium control, P<0.01 χ2). Logistic regression analysis indicated that enteral water and hydrocortisone were risk factors for significant intestinal morbidity. Conclusions: Enteral sterile water for hypernatremia appears to be associated with significant intestinal morbidity in infants ≤1000 g. Hydrocortisone is also a risk factor.