Enteral Water for ELBW infants

HustonRK, Dietz AM, Campbell BB, et al. Enteral water for hypernatremia and intestinal morbidity in infants less than or equal to 1000 g birth weight. J Perinatol (Jan 2007); 27:32–38. Full Text | PDF .

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 ² 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 ²). 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.

Comments: Enteral water supplementation in hypernatremic ELBW infants is associated with an increased risk of nectrtizing enterocolitis and spontaneous intestinal perforations. Let’s stick with IV fluids and high humidity to avoid dehydration and hypernatremia in these infants. ABK.

We have used enteral sterile water to treat hypernatremia in a small number of extreme low birth weight infants without experiencing such intestinal morbidity. However we have used this therapy when infants developed uncontrollable hyperglycemia secondary to large volume of intravenous glucose water infusion. Furthermore the percentage of enteral water used was not exceeding 30% of the total fluid intake delivered to the infant.

UserName: Saleh Al-Alaiyan
Institution: King Faisal Specialist Hospital & Research Centre
telephone: 00966-1-442 7762
email: alaiyan@kfshrc.edu.sa

This maybe a validation that feedings should be started with breastmilk and not with water.

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