Fluid status in the first 10 days of life and death/bronchopulmonary dysplasia among preterm infants

Soullane, Safiya; Patel, Sharina; Claveau, Martine; Wazneh, Laila; Sant’Anna, Guilherme M.; Beltempo, Marc

doi:10.1038/s41390-021-01485-8

Cited by 19 publications

(5 citation statements)

References 36 publications

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“…Altogether, these findings support the notion that early sodium provision should be restricted until S-Na drops and weight loss is underway [11,12]. Indeed, extremely preterm infants also seem to have the ability to regulate urinary output and thus to handle an interval of fluid volumes in the maintenance range, even early after birth [13][14][15].…”

Section: Discussionsupporting

confidence: 70%

The Impact of Restricted versus Liberal Early Fluid Volumes on Plasma Sodium, Weight Change, and Short-Term Outcomes in Extremely Preterm Infants

et al. 2022

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The optimal fluid requirements for extremely preterm infants are not fully known. We examined retrospectively the fluid intakes during the first week of life in two cohorts of extremely preterm infants born at 22–26 weeks of gestation before (n = 63) and after a change from a restrictive to a more liberal (n = 112) fluid volume allowance to improve nutrient provision. The cohorts were similar in gestational age and birth weight, but antenatal steroid exposure was more frequent in the second era. Although fluid management resulted in a cumulative difference in the total fluid intake over the first week of 87 mL/kg (p < 0.001), this was not reflected in a mean weight loss (14 ± 5% at a postnatal age of 4 days in both groups) or mean peak plasma sodium (142 ± 5 and 143 ± 5 mmol/L in the restrictive and liberal groups, respectively). The incidences of hypernatremia (>145 and >150 mmol/L), PDA ligation, bronchopulmonary dysplasia, and IVH were also similar. We conclude that in this cohort of extremely preterm infants a more liberal vs. a restricted fluid allowance during the first week had no clinically important influence on early changes in body weight, sodium homeostasis, or hospital morbidities.

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Section: Discussionsupporting

confidence: 70%

The Impact of Restricted versus Liberal Early Fluid Volumes on Plasma Sodium, Weight Change, and Short-Term Outcomes in Extremely Preterm Infants

et al. 2022

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“…All included studies reported that fluid restriction in the early days will decrease the risk of BPD [7,[14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

“…In this study, the multivariable logistic regression analysis revealed that higher cumulative fluid balance was linked to increased odds of death (BPD). The absolute odds ratio (AOR) was 1.56, and the 95% confidence interval limit was (CI 1.11-2.25) [15].…”

Section: Snmentioning

confidence: 99%

A Systematic Review: Is Early Fluid Restriction in Preterm Neonates Going to Prevent Bronchopulmonary Dysplasia?

Bollaboina,

Urakurva,

Kamsetti

et al. 2023

Cureus

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Preterm birth causes constant challenges, with bronchopulmonary dysplasia (BPD) being a major concern. Immediately after birth, it takes time to establish feeding between the mother and the premature baby. During this time, the telological shifting of fluid from extracellular space to intracellular space will help the baby; this transition should be smooth. Both normal physiologic changes and pathophysiologic events are capable of disrupting this delicate fluid shifting that occurs in very low-birth-weight infants during the first week of life. The immaturity of the renal system and evaporative losses complicate this process. This lack of fluid displacement can be associated with an increased amount of water in the lungs and reduced lung compliance. This can lead to the need for more ventilatory support and a higher oxygen requirement, which, in turn, leads to lung damage. The fluid restriction is also associated with complications such as severe dehydration, intracranial hemorrhage, and bilirubin toxicity. However, the administration of large amounts of fluid and salt is associated with an increased incidence of patent ductus arteriosus, BPD, necrotizing enterocolitis, and intraventricular hemorrhage. There were studies conducted in both the pre-surfactant and surfactant eras that were inconclusive regarding fluid restriction in BPD. We only included very recent studies. This systematic review attempts to summarize the current evidence, focusing on the efficacy and safety of early fluid management in preterm infants. This reduces the risk of BPD and improves outcomes for premature infants. As we know, intact survival is very important. Our review supported the early fluid restriction.

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“…Rallis et al ( 21 ) concluded that a day-1 fluid overload ≥5% was significantly associated with hs PDA in VLBWI. More recently, Soullan et al ( 6 ) observed the 10-day postnatal fluid status in 191 preterm infants with GA ≤ 28 weeks and concluded that fluid overload in the first 10 days was correlated with the occurrence of a BPD/composite death outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies ( 4 , 5 ) found that a high fluid intake in the early postnatal period was associated with the occurrence and severity of BPD in VLBWI. A recent study ( 6 ) investigated the association between fluid and sodium status in the first 10 postnatal days and death/ BPD among infants born, they concluded that a higher CFB in the first 10 days after delivery was associated with higher odds of death/BPD among preterm infants. It has also been reported that there is an association between total sodium intake and BPD within the first 2 weeks of life among ELBW infants ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Influence of early fluid overload on bronchopulmonary dysplasia in very low-birth-weight infants

Zhu

Liu

et al. 2022

Front. Pediatr.

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ObjectiveThis study aimed to determine the influence of fluid overload on bronchopulmonary dysplasia (BPD) in very low-birth-weight infants (VLBWI) within 1 week after birth.MethodsThis was a retrospective case control study conducted in the Jingzhou Central Hospital. The clinical data of VLBWI (with a birth weight [BW] < 1,500 g and 26 weeks ≤ gestational age [GA] < 32 weeks) who were admitted to the neonatal intensive care unit of this hospital from January 2016 to December 2021 were analyzed retrospectively. A total of 157 cases were enrolled and divided into a BPD group (n = 60) and a non-BPD group (n = 97) according to whether BPD was present. The general condition, fluid intake, and fluid overload of the two groups of neonates within 1 week after birth were compared. The logistic regression was used to assess the association between infant characteristics and BPD. The ROC curve was used to assess how well the 7 day cumulative fluid overload predicted BPD, and to identify an optimal cut off for prediction.ResultsThe comparison of the patients' general condition revealed that the neonates in the BPD group had a younger GA, lower BW, lower 5-min Apgar score, longer duration of invasive mechanical ventilation, and higher incidence of intrauterine infections and administration of surfactants (P < 0.05). The differences in the other indicators were not statistically significant between the two groups. The logistic regression analysis revealed that a younger GA, the presence of intrauterine infection, and a 7-day cumulative fluid overload were the risk factors for the development of BPD. A ROC curve was plotted with the 7-day cumulative fluid overload as the test variable and BPD as the status variable. The area under the curve was 0.75 (95% confidence interval: 0.664–0.826, P = 0.042), with a sensitivity of 76.7% and a specificity of 70.1%, corresponding to a 7-day cumulative fluid overload of 36.2%.ConclusionA younger GA, the presence of intrauterine infection, and a 7-day cumulative fluid overload were risk factors for the development of BPD. A 7 day cumulative fluid overload threshold of 36.2% best predicted the development of BPD.

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Fluid status in the first 10 days of life and death/bronchopulmonary dysplasia among preterm infants

Cited by 19 publications

References 36 publications

The Impact of Restricted versus Liberal Early Fluid Volumes on Plasma Sodium, Weight Change, and Short-Term Outcomes in Extremely Preterm Infants

The Impact of Restricted versus Liberal Early Fluid Volumes on Plasma Sodium, Weight Change, and Short-Term Outcomes in Extremely Preterm Infants

A Systematic Review: Is Early Fluid Restriction in Preterm Neonates Going to Prevent Bronchopulmonary Dysplasia?

Influence of early fluid overload on bronchopulmonary dysplasia in very low-birth-weight infants

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