Hyponatremia in children under 100 days old: incidence and etiologies
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%).
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.
KeywordsHypo-osmolality Mineralocorticoid signaling pathway Newborns Prematurity Salt-wasting
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.
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.
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