The impact of fluid balance on outcomes in critically ill near-term/term neonates: a report from the AWAKEN study group
David T Selewski, Ayse Akcan-Arikan, Elizabeth M Bonachea, Katja M Gist, Stuart L Goldstein, Mina Hanna, Catherine Joseph, John D Mahan, Arwa Nada, Amy T Nathan, Kimberly Reidy, Amy Staples, Pia Wintermark, Louis J Boohaker, Russell Griffin, David J Askenazi, Ronnie Guillet, Neonatal Kidney Collaborative, Sunny Juul, Namasivayam Ambalavanan, Subrata Sarkar, Alison Kent, Jeffery Fletcher, Carolyn L Abitbol, Marissa DeFreitas, Shahnaz Duara, Jennifer R Charlton, Jonathan R Swanson, Carl D'Angio, Ayesa Mian, Erin Rademacher, Maroun J Mhanna, Rupesh Raina, Deepak Kumar, Jennifer G Jetton, Patrick D Brophy, Tarah T Colaizy, Jonathan M Klein, Christopher J Rhee, Juan C Kupferman, Alok Bhutada, Shantanu Rastogi, Susan Ingraham, F Sessions Cole, T Keefe Davis, Lawrence Milner, Alexandra Smith, Mamta Fuloria, Frederick J Kaskel, Danielle E Soranno, Jason Gien, Aftab S Chishti, Sangeeta Hingorani, Michelle Starr, Craig S Wong, Tara DuPont, Robin Ohls, Surender Khokhar, Sofia Perazzo, Patricio E Ray, Mary Revenis, Sidharth K Sethi, Smriri Rohatgi, Cherry Mammen, Anne Synnes, Sanjay Wazir, Michael Zappitelli, Robert Woroniecki, Shanty Sridhar, David T Selewski, Ayse Akcan-Arikan, Elizabeth M Bonachea, Katja M Gist, Stuart L Goldstein, Mina Hanna, Catherine Joseph, John D Mahan, Arwa Nada, Amy T Nathan, Kimberly Reidy, Amy Staples, Pia Wintermark, Louis J Boohaker, Russell Griffin, David J Askenazi, Ronnie Guillet, Neonatal Kidney Collaborative, Sunny Juul, Namasivayam Ambalavanan, Subrata Sarkar, Alison Kent, Jeffery Fletcher, Carolyn L Abitbol, Marissa DeFreitas, Shahnaz Duara, Jennifer R Charlton, Jonathan R Swanson, Carl D'Angio, Ayesa Mian, Erin Rademacher, Maroun J Mhanna, Rupesh Raina, Deepak Kumar, Jennifer G Jetton, Patrick D Brophy, Tarah T Colaizy, Jonathan M Klein, Christopher J Rhee, Juan C Kupferman, Alok Bhutada, Shantanu Rastogi, Susan Ingraham, F Sessions Cole, T Keefe Davis, Lawrence Milner, Alexandra Smith, Mamta Fuloria, Frederick J Kaskel, Danielle E Soranno, Jason Gien, Aftab S Chishti, Sangeeta Hingorani, Michelle Starr, Craig S Wong, Tara DuPont, Robin Ohls, Surender Khokhar, Sofia Perazzo, Patricio E Ray, Mary Revenis, Sidharth K Sethi, Smriri Rohatgi, Cherry Mammen, Anne Synnes, Sanjay Wazir, Michael Zappitelli, Robert Woroniecki, Shanty Sridhar
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.
Conflict of interest statement
Conflict of interest disclosures:
All authors declare no real or perceived conflicts of interest that could affect the study design, collection, analysis and interpretation of data, writing of the report, or the decision to submit for publication.
For full disclosure, we provide here an additional list of other author’s commitments and funding sources that are not directly related to this study: David J Askenazi serves on the speaker board for Baxter (Baxter, USA), and the Acute Kidney Injury (AKI) Foundation (Cincinnati, OH, USA); he also receives grant funding for studies not related to this manuscript from National Institutes of Health — National Institutes of Diabetes and Digestive and Kidney Diseases (NIH-NIDDK, R01 DK103608 and NIH-FDA (R01 FD005092).
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Source: PubMed