104 - Mother’s own milk vs donor breast milk and neonatal hyponatremia

Poster Number: 104
Publication Number: 104.461

Background: Neonatal hyponatremia is a common complication in preterm infants, it has been correlated with inadequate weight gain and neurodevelopmental complications later in life. Insufficient sodium supply is associated with late neonatal hyponatremia. Human breast milk is the standard of care for feeding preterm infants; however, its sodium content is low, especially in donor breast milk.

Objective: To identify risk factors for neonatal hyponatremia and the correlation with the type of breast milk used (donor vs maternal) for its development.

Design/Methods: A retrospective study was performed at a level III NICU. Preterm infants that developed hyponatremia (plasma sodium < 135mmol/L) as well as a control group matched for gestational age were included in the study. Infants that required diuretics, had congenital malformations, were transferred, or did not survive were excluded. Growth parameters (weight, head circumference and length) were collected at admission and discharge. Data regarding factors that could influence sodium balance, such as medications at time of diagnosis and feeding method, was recorded.

Results: There were 89 infants enrolled in the study and divided into 3 groups: those with hyponatremia that received extra sodium (32), those with hyponatremia that did not receive extra sodium (28) and those without hyponatremia (29); characteristics shown in Table 1. Compared to infants with normal sodium values, those with hyponatremia were mostly males (70% vs 44.8%), white (81.4% vs 62.1%), intubated (21.7% vs none), had lowest sodium levels (132 vs 137), presented later (14 vs 5 days old), had longer length of stay (56 vs 43 days) and were using more maternal breast milk (49.2% vs 17.9%). There was no significant difference between groups related to days of parenteral nutrition, when feeds were started, full feeds (>120cc/kg/day) achieved, or fortification given. Growth parameters at discharge were not different between groups after controlling for length of stay.

Conclusion(s): Contrary to expectation, maternal breast milk (not donor) was associated with neonatal hyponatremia. Sodium supplementation was not associated with improved growth parameters at discharge.