THE USE OF ENTERAL STERILE WATER FOR THE TREATMENTOF HYPERNATREMIAIN EXTREMELY LOW BIRTH WEIGHT INFANTS
There has been tremendous improvement in the survival rate of extremely low birth weight (ELBW) infants, but as a result, there are associated morbidities. ELBW infants are vulnerable to electrolyte imbalance, particularly hypernatremia (serum sodium value = 150 mEq/L). There are different approaches in the management of hypernatremia but little consensus as to the optimal approach. Liberal intravenous fluid administration is the standard treatment but is associated with comorbidities such as patent ductus arteriosus, bronchopulmonary dysplasia and intraventricular hemorrhage. The purpose of this prospective, randomized control trial (N=19) was to examine the use of enteral sterile water feeds as an alternative management strategy on the incidence and duration of hypernatremia; patterns in serum sodium values; magnitude of change in serum sodium values, and the relationship between the onset of hypernatremia and onset of diuresis during the first week of life. Infants in the study were = 27 weeks gestational age and = 1,100 grams birth weight. The study consisted of three groups: the control group (n=8) who received intravenous fluid; the prophylactic group (n=6) who received enteral sterile water feeds when their serum sodium value was = 145 mEq/L and the intervention group (n=5) who received enteral sterile water feeds when their serum sodium value was = 150 mEq/L. There were no statistically significant differences in the incidence, duration or magnitude of change in serum sodium values in the three groups; nor were there statistically significant differences in the onset of hypernatremia or diuresis. There were statistically significant differences when analyzing patterns of morning sodium values: from day one to two (p=.008) and day one to three (p =0.015) and from day three to (p =0.01) four and four to five (p =0.005). There was a statistically significant increase in sodium values found from day one (p=.000) to two and day two to three (p=.051)ELBW infants who received enteral sterile water feeds did not have a decrease in the incidence or duration of hypernatremia when compared to ELBW infants who did not receive ESWF. Since the sample size was small, it was not possible to identify cause and effect relationships among variables.
Nursing, Hypernatremia, extremely low birth weight infants, sterile water feeds
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Case Western Reserve University School of Graduate Studies