Hypernatremia and Intracranial Hemorrhage in Neonates

Abstract

Records of all newborn admissions over a two-year period were reviewed for the occurrence of hypernatremia and intracranial hemorrhage. When restrictive criteria for the use of sodium bicarbonate were instituted, the incidence of hypernatremia fell from 8.8 to 0.6 per cent. In addition, the frequency of intracranial hemorrhage declined over the same period (13.4 to 2.6 per cent). Hypernatremia was associated with a high mortality risk (71 per cent in the combined years). Eleven of 24 patients with hypernatremia died of intracranial hemorrhage. Intracranial hemorrhage was associated with hypernatremia or excessive sodium administration in 25 of 32 cases (81 per cent). These data suggest that excessive sodium bicarbonate administration to newborns, with or without hypernatremia, may place the infant at higher risk of intracranial hemorrhage. Thus, the newborn's sodium intake from all sources should be carefully controlled, and intakes of more than 8 mg per kilogram of body weight per 24 hours should be regarded as excessive. (N Engl J Med 291:6–10, 1974)