Abstract
Extremely low birth weight (ELBW) infants experience delayed postnatal growth and suboptimal weight gain. Additional calories and supplements are used to achieve better growth. When receiving full enteral feeds of human breast milk, the available sodium is less than the recommended 3-5 mEq/kg/day. In addition, prior research found that poor weight gain and not receiving the daily recommendation of sodium were related to late hyponatremia. This evidence-based practice project was to supplement the enteral feedings of ELBW (<1000 grams and/or 29 weeks’ gestation) infants with sodium chloride, if needed, to achieve improvements in growth as shown by the weight z-score. After full enteral feedings were reached, a serum sodium was obtained on each qualifying neonate. The neonate was then supplemented with sodium chloride based on their sodium level. An initial level of sodium <130 mEq/kg/day, supplementation was to a total of 6 mEq/kg/day. Initial level between 131-139, supplementation to a total of 4 mEq/kg/day. Initial level >140, no supplementation was indicated. Sodium was surveilled weekly while on supplementation. Once the infant had a stable serum sodium and adequate growth, the supplementation was discontinued. The change in weight z-score was used to determine adequate growth based on the standard that 0.8 difference is considered malnutrition. The goal is a z-score change between birth and discharge weight is less than 0.8. Twelve neonates were born since implementation that qualified for sodium surveillance weighing <1000 grams at birth and/or 29 weeks’ gestation. Of the total project participants (n=12), 83% of the infants required early supplementation with sodium for serum levels less than 140 mEq/L. The two infants that did not receive supplementation maintained a serum sodium of greater than 140 mEq/L. The weight z-score difference from birth to discharge was 0.36-1.63. Prior to implementation, a comparison group of similar infants in gestational age and birth weight, only 30% were supplemented with sodium. The weight z-score range of this group was 0.99-2.41. The z-score difference between birth and discharge weight in the project group was overall closer to being less than 0.8, the target change. Infants were supplemented based on the serum sodium level; a urine sodium, the gold standard, would better reflect the infant’s sodium status and need for supplementation. Additional data analysis is necessary to obtain a sample size between 40-50 to properly evaluate effectiveness. This practice change improved the weight change z-score of ELBW infants. No adverse effects were discovered with the early supplementation of sodium.