The impact of fluid balance on outcomes in critically ill near-term/term neonates: a report from the AWAKEN study group

David T. Selewski, Division of Nephrology, Department of Pediatrics & Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA. dselewsk@med.umich.edu.
Ayse Akcan-Arikan, Sections of Pediatric Critical Care Medicine and Renal, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Elizabeth M. Bonachea, Department of Pediatrics, Section of Neonatology,Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.Follow
Katja M. Gist, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Stuart L. Goldstein, Department of Pediatrics, Center for Acute Care Nephrology, Cincinnati Children's Hospital and Medical Center, University of Cincinnati, Cincinnati, OH, USA.Follow
Mina Hanna, Department Pediatrics, University of Kentucky, Lexington, KY, USA.
Catherine Joseph, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
John D. Mahan, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.
Arwa Nada, Department of Pediatrics, Division of Nephrology, LeBonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA.
Amy T. Nathan, Department of Pediatrics, Perinatal Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
Kimberly Reidy, Division of Nephrology, Department of Pediatrics, Children's Hospital at Montefiore/ Albert Einstein College of Medicine, Bronx, NY, USA.
Amy Staples, Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA.
Pia Wintermark, Department of Pediatrics, McGill University, Montreal, QC, Canada.
Louis J. Boohaker, Department of Pediatrics, Pediatric and Infant Center for Acute Nephrology (PICAN), University of Alabama Birmingham, Birmingham, AL, USA.Follow
Russell Griffin, Department of Pediatrics, Pediatric and Infant Center for Acute Nephrology (PICAN), University of Alabama Birmingham, Birmingham, AL, USA.
David J. Askenazi, Department of Pediatrics, Pediatric and Infant Center for Acute Nephrology (PICAN), University of Alabama Birmingham, Birmingham, AL, USA.Follow
Ronnie Guillet, Department of Pediatrics, Division of Neonatology, Golisano Children's Hospital, University of Rochester, Rochester, NY, USA.

Abstract

BACKGROUND: In sick neonates admitted to the NICU, improper fluid balance can lead to fluid overload. We report the impact of fluid balance in the first postnatal week on outcomes in critically ill near-term/term neonates. METHODS: This analysis includes infants ≥36 weeks gestational age from the Assessment of Worldwide Acute Kidney injury Epidemiology in Neonates (AWAKEN) study (N = 645). Fluid balance: percent weight change from birthweight. PRIMARY OUTCOME: mechanical ventilation (MV) on postnatal day 7. RESULTS: The median peak fluid balance was 1.0% (IQR: -0.5, 4.6) and occurred on postnatal day 3 (IQR: 1, 5). Nine percent required MV at postnatal day 7. Multivariable models showed the peak fluid balance (aOR 1.12, 95%CI 1.08-1.17), lowest fluid balance in 1st postnatal week (aOR 1.14, 95%CI 1.07-1.22), fluid balance on postnatal day 7 (aOR 1.12, 95%CI 1.07-1.17), and negative fluid balance at postnatal day 7 (aOR 0.3, 95%CI 0.16-0.67) were independently associated with MV on postnatal day 7. CONCLUSIONS: We describe the impact of fluid balance in critically ill near-term/term neonates over the first postnatal week. Higher peak fluid balance during the first postnatal week and higher fluid balance on postnatal day 7 were independently associated with MV at postnatal day 7.

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Pediatric research

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