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

Authors

• David T. Selewski, Division of Nephrology, Department of Pediatric, Medical University of South Carolina, Charleston, SC, USA. selewski@musc.edu.
• Katja M. Gist, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
• Amy T. Nathan, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
• Stuart L. Goldstein, Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.Follow
• Louis J. Boohaker, Pediatric and Infant Center for Acute Nephrology (PICAN) Department of Pediatrics, University of Alabama Birmingham, Birmingham, AL, USA.Follow
• 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
• Mina Hanna, Department Pediatrics, University of Kentucky, Lexington, KY, USA.
• Catherine Joseph, Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
• John D. Mahan, Nationwide Children's Hospital, The Ohio State University, College of Medicine, Columbus, OH, USA.
• Cherry Mammen, Division of Nephrology, British Columbia Children's Hospital (BCCH), Vancouver, BC, Canada.
• Arwa Nada, Department of Pediatrics, Division of Nephrology, LeBonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, 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.
• Russell Griffin, Pediatric and Infant Center for Acute Nephrology (PICAN) Department of Pediatrics, University of Alabama Birmingham, Birmingham, AL, USA.
• David J. Askenazi, Pediatric and Infant Center for Acute Nephrology (PICAN) Department of Pediatrics, 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: 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.

Publication Title

Pediatric research

Recommended Citation

Selewski, David T.; Gist, Katja M.; Nathan, Amy T.; Goldstein, Stuart L.; Boohaker, Louis J.; Akcan-Arikan, Ayse; Bonachea, Elizabeth M.; Hanna, Mina; Joseph, Catherine; Mahan, John D.; Mammen, Cherry; Nada, Arwa; Reidy, Kimberly; Staples, Amy; Wintermark, Pia; Griffin, Russell; Askenazi, David J.; and Guillet, Ronnie, "The impact of fluid balance on outcomes in premature neonates: a report from the AWAKEN study group" (2020). Loewenberg College of Nursing Faculty Publications. 157.
https://digitalcommons.memphis.edu/lcon-facpubs/157