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

David T Selewski, Katja M Gist, Amy T Nathan, Stuart L Goldstein, Louis J Boohaker, Ayse Akcan-Arikan, Elizabeth M Bonachea, Mina Hanna, Catherine Joseph, John D Mahan, Cherry Mammen, Arwa Nada, Kimberly Reidy, Amy Staples, Pia Wintermark, Russell Griffin, David J Askenazi, Ronnie Guillet, Neonatal Kidney Collaborative, 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, Sunny Juul, 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, Katja M Gist, Amy T Nathan, Stuart L Goldstein, Louis J Boohaker, Ayse Akcan-Arikan, Elizabeth M Bonachea, Mina Hanna, Catherine Joseph, John D Mahan, Cherry Mammen, Arwa Nada, Kimberly Reidy, Amy Staples, Pia Wintermark, Russell Griffin, David J Askenazi, Ronnie Guillet, Neonatal Kidney Collaborative, 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, Sunny Juul, 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: 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.

Conflict of interest statement

D.J.A. 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)). K.M.G. is a consultant for BioPorto. The other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The association of fluid balance and the need for mechanical ventilation on postnatal day 7

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