According to David E. Hertz, author of "Care of the Newborn: A Handbook for Primary Care," high blood sodium levels, or hypernatremia, in your newborn or preemie can be caused by hormones and loss of water from her body. There are several ways this can happen.
Function
Your baby's blood sodium level is affected by the fluid shift in his cells, hormone regulation and sodium delivery pathways. He is born with a hormone called aldosterone that helps him retain sodium. Preemies are not able to quickly excrete sodium through their urine, which can result in high sodium blood levels. This is treated by monitoring his sodium levels, adding fluids and taking other measures to change his environment to help reduce fluid loss.
A high blood sodium level may indicate that he is losing body fluids to his environment. This can lead to dehydration.
Considerations
Premature infants spend the first days of their lives in incubators in the hospital nursery or special care unit. The incubator has a temperature-controlled environment that makes your baby comfortable and helps her become accustomed to air temperature. She may also be wrapped in special blankets to help control fluid loss to the air.
Significance
All newborns, but especially preemies, can lose body water to the environment; this is known as insensible water loss. If your baby has a high sodium blood level, he may be too warm due to a radiant warmer or he may not be getting enough fluids -- usually by an intravenous line into his vein. If he is undergoing phototherapy for a high billirubin level, the light may be the culprit. In addition, some congenital defects cause sodium imbalance, and finally, if he has difficulty breathing, he may be losing additional fluid. His aldosterone level will also play a part in causing a high blood sodium level, which is not unusual in preemies.
Management
Your doctor may have the nurses increase the humidity level in your baby's incubator to 60 to 70 percent if the air is too dry. If she is on a radiant warmer, it may be removed from her incubator or the temperature adjusted. She may have warmed and humidified oxygen introduced to her environment. If she is being treated for respiratory problems, extra moisture can be added to the the gases she is receiving. If she has bandages or dressings, they can be changed to semipermeable ones that allow the humid air to reach her skin. She will have her IV fluids changed and monitored based on the amount of urine she excretes. If she has a congenital abnormality such as a problem with her abdominal wall, once it is repaired, her sodium levels will begin to improve.
Tip
It is difficult to determine your baby's sodium needs in the first few days of life because of many variables, especially in preemies. Your doctor will monitor your baby's weight and urine output in addition to his sodium levels. Your baby will most likely undergo frequent blood tests to monitor his sodium levels to be sure his imbalances are responding to treatment. All the tests can be hard for parents who worry that their baby is experiencing a lot of pain and suffering. This is a normal fear. Talk with your doctor and the nurses; they are there to support you as well.
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