The impact of fluid balance on outcomes in premature neonates: a report from the AWAKEN study group

Abstract

16 on behalf of the Neonatal Kidney Collaborative BACKGROUND: We evaluated the epidemiology of fluid balance (FB) over the first postnatal week and its impact on outcomes in a multi-center cohort of premature neonates from the AWAKEN study. METHODS: Retrospective analysis of infants <36 weeks' gestational age from the AWAKEN study (N = 1007). FB was defined by percentage of change from birth weight. Outcome: Mechanical ventilation (MV) at postnatal day 7. RESULTS: One hundred and forty-nine (14.8%) were on MV at postnatal day 7. The median peak FB was 0% (IQR: −2.9, 2) and occurred on postnatal day 2 (IQR: 1,5). Multivariable models showed that the peak FB (aOR 1.14, 95% CI 1.10-1.19), lowest FB in first postnatal week (aOR 1.12, 95% CI 1.07-1.16), and FB on postnatal day 7 (aOR 1.10, 95% CI 1.06-1.13) were independently associated with MV on postnatal day 7. In a similar analysis, a negative FB at postnatal day 7 protected against the need for MV at postnatal day 7 (aOR 0.21, 95% CI 0.12-0.35). CONCLUSIONS: Positive peak FB during the first postnatal week and more positive FB on postnatal day 7 were independently associated with MV at postnatal day 7. Those with a negative FB at postnatal day 7 were less likely to require MV.

Renal Precision Medicine in Neonates and Acute Kidney Injury: How to Convert a Cloud of Creatinine Observations to Support Clinical Decisions

“…Fluid overload and daily weight balance (change% = current weight – birthweight/current weight) in the 1st week of life were used as alternative markers. Based on these markers, a higher positive peak in the 1st week of life and a positive fluid balance on day 7 were associated with mechanical ventilation ( 36 ).…”

“…A negative fluid balance was observed in 53% of neonates (21 vs. 41% in ventilated vs. non-ventilated neonates). Those with AKI had a consistently higher fluid balance throughout the 1st week of life ( 36 ). Suggested nephro-protective interventions include “low dose dopamine” or methylxanthines, like theophylline ( 57 ).…”

Acute kidney injury among preterm infants receiving non-steroidal anti-inflammatory drugs for patent ductus arteriosus

“…However, data from our symptomatic treatment cohort suggests that the transient oliguria may still be associated with clinically relevant uid overload with a high maximal percentage of weight gain (median 11.1%, IQR 6.2-17.6%) observed from baseline. This is especially relevant with a recent analysis of 1007 premature infants from the landmark AWAKEN study showing that a positive peak uid balance during the rst postnatal week and the degree of positive uid balance by day 7 of life were both independently associated for the need for mechanical ventilation at postnatal day 7 [20].…”

Fluid Balance in the Critically Ill Child Section: “How Bad Is Fluid in Neonates?”

“…More recent investigations explored the link between neonatal fluid balance and mechanical ventilation and found FO in the first 72 h of life was associated with higher ventilator settings and longer duration of mechanical ventilation (29). In a secondary analysis of the AWAKEN cohort (42), Selewski et al demonstrated multiple measurements of positive fluid balance as risk factors for the need for mechanical ventilation at the end of the first week of life (30,31); every 1% increase in peak fluid balance led to a 12-14% increased risk of requiring mechanical ventilation on postnatal day 7, suggesting even incremental fluid changes can adversely affect lung function.…”