362 - Impact of Early Fluid and Electrolyte Management on Neonatal Outcomes

Poster Number: 362
Publication Number: 362.132

Tara M. Beck, NemoursAlfred I. duPont Hospital for Children, Wilmington, DE, United States; Kelley Z. Kovatis, Christiana Care, Philadelphia, PA, United States; Deborah Tuttle, Christiana Care Health System, Newark, DE, United States; Keshab Subedi, Christiana Care Health Systems, Wilmington, DE, United States

Background: Fluid management in the extremely premature infant poses many challenges due to increased total body water, renal immaturity, and insensible water loss. Electrolyte and fluid imbalances must be prevented while allowing normal physiologic changes after birth. Extremely liberal or restrictive fluid management strategies increase morbidity and mortality. Clinicians often use weight changes and serum electrolytes within the first week of life to determine individual fluid goals but no absolute standard has been established and practice variation exists.

Objective: To determine the variables that dictate fluid management in a large level 3 NICU and the impact management strategies have on neonatal morbidity. 

Design/Methods: Retrospective observational cohort study of infants ≤28 weeks gestation (GA) born at a  single center NICU. Extensive chart review to determine variables impacting fluid management during the first 2 weeks of life and to correlate fluid management to discharge outcomes (Bronchopulmonary Dysplasia (BPD), Patent Ductus Arteriosus (PDA) and Necrotizing Enterocolitis (NEC).

Results: Included 184 infants with GA of 26.7 (IQR 22.29-29 ) weeks and birthweight of 864 (±236) grams (Table 1). Minimal within and between subject variability in fluid intake (AFL) during the first 2 weeks of life regardless of GA, birthweight, serum sodium, BUN, creatinine, or weight loss (%). Maximum DOL1 sodium positively correlated with AFL. AFL higher in PDA (135.93±7.95 vs 132.97±8.65, p=0.026) but not in BPD or NEC (Figure 1). 52% diagnosed with BPD, 35% with IVH, 52% with PDA, and 10% with NEC. Weight loss from birth to DOL5 significantly lower in BPD (BPD vs no BPD:7.3±7.57 vs 9.91±5.39, p=0.024), and PDA (PDA vs No PDA:6.7±7.37 vs 9.7±6.07, p=0.006). Weight loss did not impact NEC. In multivariable model, GA inversely associated with BPD and PDA.  Weight loss DOL0-5 associated with decreased odds of PDA (OR: 0.92, p=0.021). AFL inversely associated with odds of PDA (OR=0.92, P=0.002). Effect of weight loss on PDA is modified by GA. For infants >27 weeks GA, the odd of PDA decreased by 13% for each percent increase in weight loss. The  effect not significant for infants with GA  ≤27 weeks. Conclusion(s): Fluid management did not correlate with objective measures of fluid status but early fluid management modified BPD and PDA risk.  Allowing for increased weight loss may decrease BPD and PDA in infants born at < 28 weeks GA. Prospective studies assessing the impact of early weight loss on neonatal outcomes are needed.
Table 1Demographic and Clinical Data
Figure 1Weight loss (%) from birth to DOL5 (top) and Mean AFL from birth to DOL14 (bottom) with and without BPD, PDA and NEC.