From the Guidelines
Three percent saline solution has a limited role in neonatal care, primarily used for the treatment of severe symptomatic hyponatremia and management of increased intracranial pressure. For severe hyponatremia (serum sodium <125 mEq/L) with neurological symptoms, 3% saline can be administered at 2-5 mL/kg over 10-15 minutes, with a goal of increasing serum sodium by 4-6 mEq/L in the first few hours 1. The maximum correction rate should not exceed 8-10 mEq/L in 24 hours to avoid osmotic demyelination syndrome. When treating increased intracranial pressure, 3% saline may be given at 2-5 mL/kg boluses. Administration requires central venous access when possible due to the solution's high osmolarity, which can cause peripheral vein irritation. Continuous cardiac monitoring is essential during infusion, and frequent electrolyte measurements (every 2-4 hours initially) are necessary to prevent overcorrection.
The use of 3% saline in neonates is supported by studies that demonstrate its effectiveness in reducing intracranial pressure and increasing serum sodium concentration 1. However, it is essential to note that the evidence for its use in neonates is largely extrapolated from adult and pediatric studies, and more research is needed to establish its safety and efficacy in this population.
Key considerations when using 3% saline in neonates include:
- Careful dosing and monitoring due to immature renal function and higher body water content
- Central venous access when possible to avoid peripheral vein irritation
- Continuous cardiac monitoring during infusion
- Frequent electrolyte measurements to prevent overcorrection
- Goal of increasing serum sodium by 4-6 mEq/L in the first few hours, with a maximum correction rate not exceeding 8-10 mEq/L in 24 hours.
Overall, the use of 3% saline in neonates should be guided by the principles of careful dosing, monitoring, and consideration of the potential risks and benefits, as supported by the available evidence 1.
From the Research
Role of 3% Saline in Neonates
- The provided studies do not specifically focus on the role of 3% saline in neonates, but rather on its use in pediatric patients with raised intracranial pressure due to various causes.
- However, the studies suggest that 3% hypertonic saline can be effective in reducing intracranial pressure in pediatric patients, with some studies showing improved outcomes compared to mannitol 2, 3, 4, 5.
- A systematic review and meta-analysis found that hypertonic saline appears to reduce intracranial pressure in children with cerebral edema, but more research is needed to determine the safest dose regimens and therapeutic hypernatremia threshold 6.
Key Findings
- A randomized clinical trial found that 3% hypertonic saline was associated with a greater reduction of intracranial pressure compared to 20% mannitol in pediatric acute CNS infections 2.
- Another study found that 3% hypertonic saline was a safe and effective alternative to mannitol in managing cerebral edema, with significant reductions in intracranial pressure and coma hours 3.
- A retrospective chart review found that continuous infusions of 3% hypertonic saline effectively lowered intracranial pressure in pediatric patients with closed head injury, with no adverse effects noted 4.
- A study on the efficacy and safety of continuous micro-pump infusion of 3% hypertonic saline combined with furosemide found that it was effective and safe for intracranial pressure control 5.
Limitations
- The provided studies do not specifically address the use of 3% saline in neonates, and more research is needed to determine its safety and efficacy in this population.
- The studies have varying methodologies and patient populations, making it difficult to draw firm conclusions about the optimal dose regimens and therapeutic hypernatremia threshold for 3% hypertonic saline 6.