{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T15:06:58Z","timestamp":1789225618343,"version":"build-2803163510"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009094","name":"Turun Yliopistollisen Keskussairaalan Koulutus- ja Tutkimuss\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009094","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005744","name":"Lastentautien Tutkimuss\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["240099, 240413, 250334"],"award-info":[{"award-number":["240099, 240413, 250334"]}],"id":[{"id":"10.13039\/501100005744","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005744","name":"Lastentautien Tutkimuss\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["210225, 240032"],"award-info":[{"award-number":["210225, 240032"]}],"id":[{"id":"10.13039\/501100005744","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009420","name":"Varsinais-Suomen Sairaanhoitopiiri","doi-asserted-by":"publisher","award":["30013"],"award-info":[{"award-number":["30013"]}],"id":[{"id":"10.13039\/501100009420","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009420","name":"Varsinais-Suomen Sairaanhoitopiiri","doi-asserted-by":"publisher","award":["13255"],"award-info":[{"award-number":["13255"]}],"id":[{"id":"10.13039\/501100009420","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005609","name":"University of Turku","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005609","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>To investigate the association between early hyponatremia and long-term neurodevelopmental diagnoses in infants with perinatal asphyxia. This retrospective study included infants born at\u2009\u2265\u200936\u00a0weeks of gestation with an ICD-10 diagnosis of perinatal asphyxia and\/or hypoxic-ischemic encephalopathy. Data on sodium levels within the first 72\u00a0h of life, early postnatal weight change, and clinical follow-up were extracted from medical records. The outcome was death or any ICD-10 diagnoses indicating a neurodevelopmental disorder (NDD), including epileptic, paralytic, hearing, visual and psychiatric\/developmental disorders. For multivariable analysis, estimates were adjusted for sex, mode of delivery, and therapeutic hypothermia. Among 269 neonates, 193 (71.7%) had at least one sodium value\u2009&lt;\u2009135\u00a0mmol\/l, 71 (26.4%)\u2009&lt;\u2009130\u00a0mmol\/l and 12 (4.5%)\u2009&lt;\u2009125\u00a0mmol\/l during the first 72\u00a0h of life. The median follow-up time was 11.2\u00a0years (range 2.4 \u2013 14.8). NDD or death occurred in 57 infants (21.2%). In multivariable analyses, sodium\u2009&lt;\u2009125\u00a0mmol\/l was significantly associated with NDD or death (aOR\u2009=\u20093.85, 95% Cl 1.04\u201414.22). Sodium\u2009&lt;\u2009130\u00a0mmol\/l was significantly associated with cerebral palsy (aOR\u2009=\u20098.94, 95% Cl 2.24\u201435.67), epilepsy (aOR\u2009=\u200920.75, 95% Cl 2.39\u2014180.23) and hearing disorders (aOR\u2009=\u20096.09, 95% CI 1.32\u201428.18).<\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusions<\/jats:italic>\n                    : Our study shows that hyponatremia during the first 72\u00a0h of life in infants with perinatal asphyxia is associated with an increased risk of later neurodevelopmental disorders. It remains unclear whether hyponatremia contributes causally to adverse outcomes or primarily serves as a biomarker of severe injury.\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is Known:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Perinatal asphyxia may lead to long-term neurodevelopmental disorders, including cognitive impairment, epilepsy, cerebral palsy, and sensory impairments.<\/jats:italic>\n                              \u2022\n                              <jats:italic>Hyponatremia is common in infants with birth asphyxia and has been associated with low Apgar scores and the severity of hypoxic-ischemic encephalopathy.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              \u2022\n                              <jats:italic>In this study, ICD-10 diagnoses of neurological disorders following perinatal asphyxia were examined using an extended follow-up period.<\/jats:italic>\n                              \u2022\n                              <jats:italic>Early hyponatremia was significantly associated with cerebral palsy, epilepsy and hearing disorders.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-026-07325-3","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T16:41:08Z","timestamp":1786466468000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between early hyponatremia and neurological diagnoses in infants with perinatal asphyxia"],"prefix":"10.1007","volume":"185","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8673-9310","authenticated-orcid":false,"given":"Niina","family":"Viitaharju","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6296-6797","authenticated-orcid":false,"given":"Kjell","family":"Helenius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7278-6511","authenticated-orcid":false,"given":"Eliisa","family":"L\u00f6yttyniemi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1482-904X","authenticated-orcid":false,"given":"Bishwesvar","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9281-8154","authenticated-orcid":false,"given":"Vilhelmiina","family":"Parikka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"7325_CR1","doi-asserted-by":"publisher","DOI":"10.1136\/ADC.2003.047985","author":"V Pierrat","year":"2005","unstructured":"Pierrat V, Haouari N, Liska A, Thomas D, Subtil D, Truffert P (2005) Prevalence, causes, and outcome at 2 years of age of newborn encephalopathy: population based study. Arch Dis Child Fetal Neonatal Ed. https:\/\/doi.org\/10.1136\/ADC.2003.047985","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"2","key":"7325_CR2","doi-asserted-by":"publisher","DOI":"10.3390\/BIOMEDICINES10020347","volume":"10","author":"D Mota-Rojas","year":"2022","unstructured":"Mota-Rojas D, Villanueva-Garc\u00eda D, Solimano A, Muns R, Ibarra-R\u00edos D, Mota-Reyes A (2022) Pathophysiology of perinatal asphyxia in humans and animal models. Biomedicines 10(2):347. https:\/\/doi.org\/10.3390\/BIOMEDICINES10020347","journal-title":"Biomedicines"},{"key":"7325_CR3","doi-asserted-by":"publisher","unstructured":"Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG (2013) Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev 2013(1). https:\/\/doi.org\/10.1002\/14651858.CD003311.PUB3","DOI":"10.1002\/14651858.CD003311.PUB3"},{"issue":"3","key":"7325_CR4","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1053\/J.NAINR.2011.07.004","volume":"11","author":"KA Allen","year":"2011","unstructured":"Allen KA, Brandon DH (2011) Hypoxic ischemic encephalopathy: pathophysiology and experimental treatments. Newborn Infant Nurs Rev 11(3):125\u2013133. https:\/\/doi.org\/10.1053\/J.NAINR.2011.07.004","journal-title":"Newborn Infant Nurs Rev"},{"issue":"6","key":"7325_CR5","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1111\/APA.14234","volume":"107","author":"E Leinonen","year":"2018","unstructured":"Leinonen E et al (2018) Low Apgar scores at both one and five minutes are associated with long-term neurological morbidity. Acta Paediatr 107(6):942\u2013951. https:\/\/doi.org\/10.1111\/APA.14234","journal-title":"Acta Paediatr"},{"issue":"13","key":"7325_CR6","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1177\/0883073817726681","volume":"32","author":"I S\u00e1nchez Fern\u00e1ndez","year":"2017","unstructured":"S\u00e1nchez Fern\u00e1ndez I, Morales-Quezada JL, Law S, Kim P (2017) Prognostic value of brain magnetic resonance imaging in neonatal hypoxic-ischemic encephalopathy: a meta-analysis. J Child Neurol 32(13):1065\u20131073. https:\/\/doi.org\/10.1177\/0883073817726681","journal-title":"J Child Neurol"},{"key":"7325_CR7","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/J.PEDIATRNEUROL.2018.12.013","volume":"93","author":"Y Han","year":"2019","unstructured":"Han Y et al (2019) Prognostic value of electroencephalography in hypothermia-treated neonates with hypoxic-ischemic encephalopathy: a meta-analysis. Pediatr Neurol 93:3\u201310. https:\/\/doi.org\/10.1016\/J.PEDIATRNEUROL.2018.12.013","journal-title":"Pediatr Neurol"},{"issue":"6","key":"7325_CR8","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1007\/S12519-023-00698-7","volume":"19","author":"I Caramelo","year":"2023","unstructured":"Caramelo I et al (2023) Biomarkers of hypoxic-ischemic encephalopathy: a systematic review. World J Pediatr 19(6):505\u2013548. https:\/\/doi.org\/10.1007\/S12519-023-00698-7","journal-title":"World J Pediatr"},{"issue":"7756","key":"7325_CR9","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1136\/BMJ.C1471","volume":"340","author":"GL Malin","year":"2010","unstructured":"Malin GL, Morris RK, Khan KS (2010) Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis. BMJ 340(7756):1121. https:\/\/doi.org\/10.1136\/BMJ.C1471","journal-title":"BMJ"},{"issue":"10","key":"7325_CR10","doi-asserted-by":"publisher","first-page":"1801","DOI":"10.1111\/APA.14812","volume":"108","author":"E Leinonen","year":"2019","unstructured":"Leinonen E et al (2019) Umbilical artery pH and base excess at birth are poor predictors of neurodevelopmental morbidity in early childhood. Acta Paediatr 108(10):1801\u20131810. https:\/\/doi.org\/10.1111\/APA.14812","journal-title":"Acta Paediatr"},{"issue":"6","key":"7325_CR11","doi-asserted-by":"publisher","DOI":"10.7759\/CUREUS.26115","volume":"14","author":"AK Pyati","year":"2022","unstructured":"Pyati AK et al (2022) Association of cord blood glucose, sodium, potassium, and calcium levels with neonatal birth asphyxia: a hospital-based study. Cureus 14(6):e26115. https:\/\/doi.org\/10.7759\/CUREUS.26115","journal-title":"Cureus"},{"issue":"5","key":"7325_CR12","doi-asserted-by":"publisher","first-page":"125","DOI":"10.18203\/issn.2454-2156.IntJSciRep20191859","volume":"5","author":"A Islam","year":"2019","unstructured":"Islam A et al (2019) Correlation of Apgar score with serum glucose, calcium and electrolytes on the asphyxiated neonates. Int J Sci Rep 5(5):125\u2013129. https:\/\/doi.org\/10.18203\/issn.2454-2156.IntJSciRep20191859","journal-title":"Int J Sci Rep"},{"issue":"4","key":"7325_CR13","doi-asserted-by":"publisher","first-page":"331","DOI":"10.4103\/MJBL.MJBL_52_19","volume":"16","author":"BA Hasan","year":"2019","unstructured":"Hasan BA, Al-Ani MH (2019) Electrolyte disturbance in asphyxiated neonates in maternity hospital in Erbil, Iraq. Med J Babylon 16(4):331\u2013334. https:\/\/doi.org\/10.4103\/MJBL.MJBL_52_19","journal-title":"Med J Babylon"},{"issue":"3","key":"7325_CR14","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1007\/S12098-010-0034-0","volume":"77","author":"P Basu","year":"2010","unstructured":"Basu P, Som S, Das H, Choudhuri N (2010) Electrolyte status in birth asphyxia. Indian J Pediatr 77(3):259\u2013262. https:\/\/doi.org\/10.1007\/S12098-010-0034-0","journal-title":"Indian J Pediatr"},{"issue":"4","key":"7325_CR15","doi-asserted-by":"publisher","first-page":"385","DOI":"10.3233\/NPM-1839","volume":"12","author":"KE Odo","year":"2019","unstructured":"Odo KE, Odetunde OI, Chinawa JM, Okafor HU, Aronu AE, Adimora GN (2019) Comparison of plasma electrolytes of perinatally asphyxiated and normal term babies. J Neonatal Perinatal Med 12(4):385\u2013389. https:\/\/doi.org\/10.3233\/NPM-1839","journal-title":"J Neonatal Perinatal Med"},{"issue":"11","key":"7325_CR16","doi-asserted-by":"publisher","first-page":"5108","DOI":"10.4103\/JFMPC.JFMPC_676_24","volume":"13","author":"SV Bhoye","year":"2024","unstructured":"Bhoye SV, Bhongale ND, Thorat RM, Wade PA (2024) Biochemical profile of term neonates with perinatal asphyxia and their correlation with severity of asphyxia. J Family Med Prim Care 13(11):5108\u20135112. https:\/\/doi.org\/10.4103\/JFMPC.JFMPC_676_24","journal-title":"J Family Med Prim Care"},{"key":"7325_CR17","doi-asserted-by":"publisher","DOI":"10.1186\/S13052-018-0496-7","author":"J Thakur","year":"2018","unstructured":"Thakur J, Bhatta NK, Singh RR, Poudel P, Lamsal M, Shakya A (2018) Prevalence of electrolyte disturbances in perinatal asphyxia: a prospective study. Ital J Pediatr. https:\/\/doi.org\/10.1186\/S13052-018-0496-7","journal-title":"Ital J Pediatr"},{"issue":"1","key":"7325_CR18","doi-asserted-by":"publisher","first-page":"17","DOI":"10.4103\/JMEDSCI.JMEDSCI_93_20","volume":"41","author":"K Bahatkar","year":"2021","unstructured":"Bahatkar K, Aundhakar CD (2021) Electrolyte status and plasma glucose levels in birth asphyxia: A case-control study. J Med Sci (Taiwan) 41(1):17\u201321. https:\/\/doi.org\/10.4103\/JMEDSCI.JMEDSCI_93_20","journal-title":"J Med Sci (Taiwan)"},{"key":"7325_CR19","doi-asserted-by":"publisher","DOI":"10.7759\/CUREUS.11407","author":"A Acharya","year":"2020","unstructured":"Acharya A et al (2020) Clinico-biochemical correlation in birth asphyxia and its effects on outcome. Cureus. https:\/\/doi.org\/10.7759\/CUREUS.11407","journal-title":"Cureus"},{"key":"7325_CR20","unstructured":"Comparison of serum electrolytes abnormality and renal function status in asphyxiated and normal baby in a tertiary level hospital - PubMed.\u201d [Online]. Available: https:\/\/pubmed.ncbi.nlm.nih.gov\/30487486\/. Accessed 21 Jun 2025"},{"key":"7325_CR21","doi-asserted-by":"publisher","unstructured":"Prempunpong C, Efanov I, Sant\u2019Anna G (2013) The effect of the implementation of therapeutic hypothermia on fluid balance and incidence of hyponatremia in neonates with moderate or severe hypoxic-ischaemic encephalopathy. Acta Paediatr 102(11). https:\/\/doi.org\/10.1111\/APA.12362","DOI":"10.1111\/APA.12362"},{"key":"7325_CR22","doi-asserted-by":"publisher","unstructured":"Meena J et al (2024) Acute kidney injury in neonates: a meta-analysis. Pediatrics 154(1). https:\/\/doi.org\/10.1542\/PEDS.2023-065182\/197493","DOI":"10.1542\/PEDS.2023-065182\/197493"},{"issue":"9","key":"7325_CR23","doi-asserted-by":"publisher","first-page":"922","DOI":"10.1055\/S-0039-1701024","volume":"38","author":"O Bozkurt","year":"2021","unstructured":"Bozkurt O, Yucesoy E (2021) Acute kidney injury in neonates with perinatal asphyxia receiving therapeutic hypothermia. Am J Perinatol 38(9):922\u2013929. https:\/\/doi.org\/10.1055\/S-0039-1701024","journal-title":"Am J Perinatol"},{"issue":"11","key":"7325_CR24","doi-asserted-by":"publisher","first-page":"1512","DOI":"10.1038\/S41372-018-0223-7","volume":"38","author":"V Tanigasalam","year":"2018","unstructured":"Tanigasalam V, Plakkal N, Vishnu Bhat B, Chinnakali P (2018) Does fluid restriction improve outcomes in infants with hypoxic ischemic encephalopathy? A pilot randomized controlled trial. J Perinatol 38(11):1512\u20131517. https:\/\/doi.org\/10.1038\/S41372-018-0223-7","journal-title":"J Perinatol"},{"key":"7325_CR25","doi-asserted-by":"publisher","unstructured":"Ananthan A, Balasubramanian H, Nanavati R, Raghavendra P (2025) Fluid restriction for term infants with hypoxic-ischemic encephalopathy following perinatal asphyxia-a randomized controlled trial. J Trop Pediatr 71(2). https:\/\/doi.org\/10.1093\/TROPEJ\/FMAF009","DOI":"10.1093\/TROPEJ\/FMAF009"},{"issue":"20","key":"7325_CR26","doi-asserted-by":"publisher","first-page":"3521","DOI":"10.1080\/14767058.2019.1578747","volume":"33","author":"N La Haye-Caty","year":"2020","unstructured":"La Haye-Caty N, Barbosa Vargas S, Maluorni J, Rampakakis E, Zappitelli M, Wintermark P (2020) Impact of restricting fluid and sodium intake in term asphyxiated newborns treated with hypothermia. J Matern Fetal Neonatal Med 33(20):3521\u20133528. https:\/\/doi.org\/10.1080\/14767058.2019.1578747","journal-title":"J Matern Fetal Neonatal Med"}],"container-title":["European Journal of Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-07325-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00431-026-07325-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-07325-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T15:02:43Z","timestamp":1789225363000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00431-026-07325-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":26,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["7325"],"URL":"https:\/\/doi.org\/10.1007\/s00431-026-07325-3","relation":{},"ISSN":["1432-1076"],"issn-type":[{"value":"1432-1076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,11]]},"assertion":[{"value":"25 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 July 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 August 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 August 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This retrospective register-based study utilized routinely collected clinical data. The analyses were conducted using anonymized data, and according to institutional and national guidelines, ethics committee approval was not required.","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"656"}}