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Approaches to evaluation of fluid balance and management of fluid overload in neonates among neonatologists: a Neonatal Kidney Collaborative survey

Journal of Perinatology volume 43, pages 1314–1315 (2023)Cite this article

Subjects

Fluid overload, defined as pathologic positive fluid balance, is common in critically ill neonates and contributes to poor outcomes, including prolonged hospital stay and bronchopulmonary dysplasia [1]. Maintaining appropriate fluid homeostasis is imperative in high-risk neonates [2]. Little is known about the practices of assessing fluid balance and fluid management approaches in neonates. We aimed to understand current approaches to fluid balance assessment and management of fluid overload among neonatologists.

A group of pediatric nephrologists and neonatologists in the Neonatal Kidney Collaborative iteratively created a survey to evaluate these knowledge gaps. The survey was tested to assess content and design. We distributed this electronic survey between August and October 2022 to neonatology providers worldwide through a variety of mechanisms (Supplementary Item 1). Questions included unit characteristics, definitions of fluid balance and fluid overload, and management practices (Supplementary Item 1).

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Fig. 1: Summary of participants and responses to fluid overload survey.

Data availability

Data are available for sharing upon reasonable request dependent on IRB approval and data sharing agreements between institutions.

References

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Acknowledgements

The authors would like to thank Samantha Wallace (Department of Pediatrics, Indiana University School of Medicine) for help with survey design, technical editing and proofreading of this manuscript. We would like to thank the Neonatal Kidney Collaborative for their support of this project. We would like to thank all neonatologists who participated in this survey as well as the organizations which assisted with the distribution of this survey.

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Authors and Affiliations

  1. Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA

    Lindsey Gordon & David J. Askenazi

  2. Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden

    Katarina Robertsson Grossmann

  3. Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden

    Katarina Robertsson Grossmann

  4. Division of Neonatology, Department of Pediatrics, Golisano Children’s Hospital, University of Rochester Medical Center, Rochester, NY, USA

    Ronnie Guillet

  5. Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA

    Heidi Steflik

  6. Division of Neonatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WA, USA

    Matthew W. Harer

  7. Division of Nephrology, Department of Pediatrics, University of Washington and Seattle Children’s Hospital, Seattle, WA, USA

    Shina Menon

  8. Division of Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA

    David T. Selewski

  9. Division of Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

    Michelle C. Starr

  10. Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

    Michelle C. Starr

Authors
  1. Lindsey Gordon
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  2. Katarina Robertsson Grossmann
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  3. Ronnie Guillet
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  4. Heidi Steflik
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  5. Matthew W. Harer
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  6. David J. Askenazi
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  7. Shina Menon
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  8. David T. Selewski
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  9. Michelle C. Starr
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Contributions

LG, MCS: significant contributions to the design and conception, data analysis and interpretation, drafting the manuscript, critical revision of the manuscript and final approval. DJA, DTS: contributions to the design and conception, data analysis, interpretation, and critical revision of the manuscript. KRG, RG, MWH, HS: contributions to design and revision of the manuscript.

Corresponding author

Correspondence to Michelle C. Starr.

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Competing interests

All authors report no real or perceived conflicts of interest that could affect the study design, collection, analysis, and interpretation of data, the writing of the report, or the decision to submit the manuscript for publication. For full disclosure, we provide the additional list of authors’ other funding not directly related to this study. DJA is a consultant for Baxter, Nuwellis, Medtronic Bioporto, and Seastar. His institution receives grant funding for education and research that is not related to this project from NIH, Baxter, Nuwellis, Medtronic, Bioporto and Seastar. He has patents pending on inventions to improve the kidney care of neonates. He is the Founder and Chief Scientific Officer for Zorro-Flow. MCS and SM are on the medical advisory board of Nuwellis. MCS is supported in part by the Indiana University School of Medicine Physician Scientist Initiative. MCS is supported by Physician Scientist Fund at IUSM (MS). Study data were collected and managed using REDCap electronic data capture tools hosted at the Indiana Clinical and Translational Sciences Institute (Indiana CTSI) funded, in part by Grant Numbers UL1TR001108, KL2TR001106, or TL1TR001107 from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award and at the Indiana University Pervasive Technology Institute (https://pti.iu.edu/) which supports REDCap with IT infrastructure and consulting resources. The funding sources for this study had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. No other disclosures were reported.

Ethics approval and consent to participate

Patient consent was not required for this study; IRB approved at Indiana University School of Medicine.

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Gordon, L., Grossmann, K.R., Guillet, R. et al. Approaches to evaluation of fluid balance and management of fluid overload in neonates among neonatologists: a Neonatal Kidney Collaborative survey. J Perinatol 43, 1314–1315 (2023). https://doi.org/10.1038/s41372-023-01738-w

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