Laetitia Martinerie1, Eric Pussard1, Nadya Yousef1, Claudine Cosson1, Ingrid Lema1, Khaled Husseini1, Sébastien Mur1, Marc Lombès1, Pascal Boileau1. 1. Inserm (L.M., E.P., I.L., M.L.), U1185, F-94276 Le Kremlin-Bicêtre, France; Service d'Endocrinologie Pédiatrique (L.M.), Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, F-75019 Paris, France; PremUp Foundation (L.M., M.L., P.B.), F-75005 Paris, France; Université Paris Diderot (L.M.), Sorbonne Paris Cité, F-75019 Paris, France; Faculté de Médecine Paris-Sud (E.P., I.L., M.L.), UMR-S1185, Université Paris-Sud 11, F-94276 Le Kremlin-Bicêtre, France; Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie (E.P., I.L.), Service de Réanimation Pédiatrique et Néonatale (N.Y.), and Service de Biochimie (C.C.), Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre, F-94275, France; Service de Réanimation Néonatale (K.H.), CHRU, F-86000 Poitiers, France; Service de Réanimation Néonatale (S.M.), CHRU Lille Jeanne de Flandre, F-59037 Lille, France; Service d'Endocrinologie et Maladies de la Reproduction (M.L.), Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, F-94275, France; Service de Réanimation Néonatale (P.B.), CH Poissy St-Germain-en-Laye, F-78303 Poissy, France; and EA 7285, UFR des Sciences de la Santé (P.B.), Simone Veil, Université Versailles St-Quentin en Yvelines, Montigny le Bretonneux F-78180, France.
Abstract
CONTEXT: The neonatal period, notably in preterm infants, is characterized by high sodium wasting, implying that aldosterone, the main hormone regulating sodium reabsorption, is unable to maintain sodium homeostasis. OBJECTIVE: This study sought to assess aldosterone secretion and action in neonates according to gestational age (GA). DESIGN AND SETTING: This was a multicenter prospective study (NCT01176162) conducted between 2011 and 2014 at five neonatology departments in France. Infants were followed during their first 3 months. PARTICIPANTS: The 155 newborns included were classified into three groups: Group 1 (n = 46 patients), <33 gestational weeks (GW); Group 2 (n = 67 patients), 33-36 GW; and Group 3 (n = 42 patients), ≥37 GW. MAIN OUTCOME MEASURES: Plasma aldosterone was measured in umbilical cord blood. Urinary aldosterone (UAldo) was assessed at day 0, day 3, month 1, and month 3 postnatal. The correlation between UAldo and the urinary Na/K ratio was determined as an index of renal aldosterone sensitivity. RESULTS: UAldo significantly increased with GA: from 8.8 ± 7.5 μg/mmol of creatinine (Group 1) to 21.1 ± 21.0 (Group 3) in correlation with plasma aldosterone levels in all groups (P < .001), demonstrating its reliability. The aldosterone/renin ratio significantly increased with GA, suggesting an aldosterone secretion defect in preterm infants. UAldo and urinary Na/K were correlated in very preterm but not in term neonates, consistent with very preterm neonates being renal-aldosterone sensitive and term neonates being aldosterone resistant. CONCLUSIONS: Very preterm infants have a previously unrecognized defective aldosterone secretion but conserved renal aldosterone sensitivity in the neonatal period, which modifies the current view of sodium balance in these infants and suggests alternative management approaches.
CONTEXT: The neonatal period, notably in preterm infants, is characterized by high sodium wasting, implying that aldosterone, the main hormone regulating sodium reabsorption, is unable to maintain sodium homeostasis. OBJECTIVE: This study sought to assess aldosterone secretion and action in neonates according to gestational age (GA). DESIGN AND SETTING: This was a multicenter prospective study (NCT01176162) conducted between 2011 and 2014 at five neonatology departments in France. Infants were followed during their first 3 months. PARTICIPANTS: The 155 newborns included were classified into three groups: Group 1 (n = 46 patients), <33 gestational weeks (GW); Group 2 (n = 67 patients), 33-36 GW; and Group 3 (n = 42 patients), ≥37 GW. MAIN OUTCOME MEASURES: Plasma aldosterone was measured in umbilical cord blood. Urinary aldosterone (UAldo) was assessed at day 0, day 3, month 1, and month 3 postnatal. The correlation between UAldo and the urinary Na/K ratio was determined as an index of renal aldosterone sensitivity. RESULTS:UAldo significantly increased with GA: from 8.8 ± 7.5 μg/mmol of creatinine (Group 1) to 21.1 ± 21.0 (Group 3) in correlation with plasma aldosterone levels in all groups (P < .001), demonstrating its reliability. The aldosterone/renin ratio significantly increased with GA, suggesting an aldosterone secretion defect in preterm infants. UAldo and urinary Na/K were correlated in very preterm but not in term neonates, consistent with very preterm neonates being renal-aldosterone sensitive and term neonates being aldosterone resistant. CONCLUSIONS: Very preterm infants have a previously unrecognized defective aldosterone secretion but conserved renal aldosterone sensitivity in the neonatal period, which modifies the current view of sodium balance in these infants and suggests alternative management approaches.
Authors: Teresa M Seccia; Brasilina Caroccia; Elise P Gomez-Sanchez; Celso E Gomez-Sanchez; Gian Paolo Rossi Journal: Endocr Rev Date: 2018-12-01 Impact factor: 19.871
Authors: Randall D Jenkins; Julia K Aziz; Ladawna L Gievers; Harrison M Mooers; Nora Fino; David J Rozansky Journal: Pediatr Nephrol Date: 2017-07-03 Impact factor: 3.714
Authors: Zoe C Johnston; Michelle Bellingham; Panagiotis Filis; Ugo Soffientini; Denise Hough; Siladitya Bhattacharya; Marc Simard; Geoffrey L Hammond; Peter King; Peter J O'Shaughnessy; Paul A Fowler Journal: BMC Med Date: 2018-02-12 Impact factor: 8.775