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Hyponatremia in children under 100 days old: incidence and etiologies

  • Caroline Storey
  • Stéphane Dauger
  • Georges Deschenes
  • Alice Heneau
  • Olivier Baud
  • Jean Claude Carel
  • Laetitia MartinerieEmail author
Original Article

Abstract

Hyponatremia is one of the most common electrolyte disorders in hospitalized children. The underlying mechanisms are poorly understood and potentially multifactorial, making management difficult, particularly in neonates. This retrospective study aimed to determine the incidence and etiologies of hyponatremia in hospitalized children under the age of 100 days, in our pediatric tertiary care hospital over a 1-year period. The etiology of hyponatremia was determined by reviewing the data noted in each patient’s medical reports. Neonatal hyponatremia had a prevalence of 4.3% (86/2012 patients) and was mostly hospital-acquired (74/86 patients). Fifty-nine patients (68.9%) were preterm neonates. The etiology was iatrogenic in 26 cases (30.2%). In other cases, hyponatremia was due to transient (23 patients, 26.7%) or genetic abnormalities of the renal mineralocorticoid pathway (3 patients, 3.4%), SIADH (12 patients, 14%), digestive disease (3 patients, 3.5%), acute renal failure (3 patients, 3.5%), or heart failure (1 patient, 1.2%).

Conclusion: Our findings confirm that hyponatremia is a frequent electrolyte disorder in neonates. Various mechanisms underlie this condition, most of which could be prevented by optimized management. The prevalence of genetic hypoaldosteronism and pseudohypoaldosteronism was higher than expected. We provide a simple diagram to help physicians identify the mechanisms underlying neonatal hyponatremia.

What is Known:

In neonates, hyponatremia may be multifactorial, making it difficult to treat.

Newborns display partial resistance to aldosterone, and preterms have a defect in aldosterone secretion.

What is New:

Four percent of hospitalized neonates had hyponatremia, 86% hospital-acquired. Hyponatremia was due to a transient or constitutional defect of the mineralocorticoid pathway in 26/86 patients (30%) which is higher than expected.

We propose a tree diagram for improving the management of hyponatremia in neonates.

Keywords

Hypo-osmolality Mineralocorticoid signaling pathway Newborns Prematurity Salt-wasting 

Notes

Authors’ Contributions

Laetitia Martinerie designed the research.

Caroline Storey conducted the research and analyzed the data.

Caroline Storey, Laetitia Martinerie, and Jean-Claude Carel wrote the manuscript.

Stéphane Dauger, Georges Deschenes, Alice Heneau, and Olivier Baud contributed to data analysis and writing of the manuscript.

All of the authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics statement

This retrospective observational study was reviewed and approved by the local ethical review committee for biomedical research (No. 2015/172) and the French data protection authority (CNIL No. 1827596), in accordance with the Declaration of Helsinki.

Supplementary material

431_2019_3406_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 14 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Caroline Storey
    • 1
    • 2
  • Stéphane Dauger
    • 2
    • 3
  • Georges Deschenes
    • 2
    • 4
  • Alice Heneau
    • 5
  • Olivier Baud
    • 2
    • 5
    • 6
  • Jean Claude Carel
    • 1
    • 2
    • 6
  • Laetitia Martinerie
    • 1
    • 2
    • 7
    Email author
  1. 1.Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Pediatric Endocrinology and Diabetology, and Centre de Référence des Maladies Endocriniennes Rares de la CroissanceHôpital Universitaire Robert-DebréParisFrance
  2. 2.Université Paris Diderot, Sorbonne Paris CitéParisFrance
  3. 3.Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Réanimation et surveillance continue pédiatriquesHôpital Universitaire Robert-DebréParisFrance
  4. 4.Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Néphrologie HémodialyseHôpital Universitaire Robert-DebréParisFrance
  5. 5.Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Réanimation néonatale et néonatologieHôpital Universitaire Robert-DebréParisFrance
  6. 6.Institut National de la Santé et de la Recherche Médicale U1141ParisFrance
  7. 7.Institut National de la Santé et de la Recherche Médicale U1185Le Kremlin BicêtreFrance

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