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Early Chloride Intake Does Not Parallel That of Sodium in Extremely-Low-Birth-Weight Infants and May Impair Neonatal Outcomes

Kermorvant-Duchemin, Elsa*; Iacobelli, Silvia; Eleni-Dit-Trolli, Sergio*; Bonsante, Francesco; Kermorvant, Christopher*; Sarfati, Gilles; Gouyon, Jean-Bernard; Lapillonne, Alexandre*

Journal of Pediatric Gastroenterology & Nutrition: May 2012 - Volume 54 - Issue 5 - p 613–619
doi: 10.1097/MPG.0b013e318245b428
Original Articles: Hepatology and Nutrition

Background and Objective: Accurate data on the optimal chloride (Cl) intake in premature infants are scarce. The aim of the present study was to describe Cl intakes in the first 10 days of life and to assess the relations between high Cl intakes and corrected serum Cl level or markers of severe acidosis in infants <28 weeks’ gestation.

Methods: Retrospective cohort study including all of the infants <28 weeks admitted to the neonatal intensive care unit during a 3-year period and cared for from birth until day 10 or more.

Results: Fifty-six infants were included. Cumulative total Cl intakes reached 9.6 ± 3.7 mmol/kg at day 3 and 49.2 ± 13.5 mmol/kg at day 10. Inadvertent intakes (from intravenous fluids other than parenteral nutrition) represented on average 70% of total Cl intakes in the first 3 days. Difference between Cl and sodium intakes reached 7.8 ± 4.8 mmol/kg at day 10 and mainly originated from parenteral nutrition. By multivariate analysis, cumulative Cl intake >10 mmol/kg during the first 3 days was an independent risk factor of base excess <−10 mmol/L. Cumulative Cl intake >45 mmol/kg during the first 10 days was an independent risk factor of corrected chloremia >115 mmol/L and of base excess <−10 mmol/L.

Conclusions: Cumulative Cl intake >10 mmol/kg during the first 3 days (ie, 3.3 mmol · kg−1 · day−1 on average) and >45 mmol/kg during the first 10 days (ie, 4.5 mmol · kg−1 · day−1 on average) may have unwanted metabolic consequences and should be avoided. Imbalance between electrolytes provided by the parenteral nutrition solution need to be detected and corrected.

*AP-HP, Department of Neonatology, Necker-Saint-Vincent de Paul Hospital, Paris, the Paris Descartes University, Paris

Department of Paediatrics, Neonatal Intensive Care Unit, Dijon University Hospital, Dijon

AP-HP, Department of Biochemistry, Groupe Hospitalier Cochin-Saint-Vincent de Paul, Paris, France.

Address correspondence and reprint requests to Elsa Kermorvant, MD, Department of Pediatrics and Neonatal Intensive Care, Necker Hospital, 149 rue de Sevres, 75015 Paris, France (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the Journal's Web site (

Received 8 October, 2010

Accepted 11 November, 2011

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN