Title

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.
Louis J. Boohaker, Pediatric and Infant Center for Acute Nephrology (PICAN) Department of Pediatrics, University of Alabama Birmingham, Birmingham, AL, USA.
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.
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.
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

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