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  • Original Article
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Fluid regimens in the first week of life may increase risk of patent ductus arteriosus in extremely low birth weight infants

Abstract

Background:

High fluid volumes may increase neonatal morbidity. However, evidence supporting fluid restriction is inconclusive and restricting fluids may restrict caloric intake.

Objective:

To determine if higher fluid intake was associated with increased risk of patent ductus arteriosus (PDA) or bronchopulmonary dysplasia (BPD) in extremely low birth weight (ELBW) infants.

Study Design:

A total of 204 ELBW (32 weeks, 1250 g) infant survivors were grouped into low-, intermediate- and high-fluid groups. χ2 analyzed proportions of subjects with and without morbidities across groups. Logistic regression quantified increased risk of PDA or BPD associated with fluid intake while controlling for confounders. Analysis of variance compared differences in caloric intake across groups.

Result:

After controlling for gestational age, severity of illness and weight change, fluid intake on day 2 (odds ratio (OR) 1.014; confidence interval (CI) 1.001 to 1.028) and day 3 (OR 1.022; CI 1.004 to 1.040) was associated with increased risk of PDA.

Conclusion:

High fluid intake (>170 ml kg−1 day−1) in the first days of life is associated with increased risk of PDA.

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References

  1. Bell EF, Warburton D, Stonestreet BS, Oh W . Effect of fluid administration on the development of symptomatic patent ductus arteriosus and congestive heart failure in premature infants. N Engl J Med 1980; 302 (11): 598–604.

    Article  CAS  Google Scholar 

  2. Brown ER, Stark A, Sosenko I, Lawson EE, Avery ME . Bronchopulmonary dysplasia: possible relationship to pulmonary edema. J Pediatr 1978; 92 (6): 982–984.

    Article  CAS  Google Scholar 

  3. Hallman M, Merritt TA, Bry K, Berry C . Association between neonatal care practices and efficacy of exogenous human surfactant: results of a bicenter randomized trial. Pediatrics 1993; 91 (3): 552–560.

    CAS  PubMed  Google Scholar 

  4. Marshall DD, Kotelchuck M, Young TE, Bose CL, Kruyer L, O’Shea TM . Risk factors for chronic lung disease in the surfactant era: a North Carolina population-based study of very low birth weight infants. North Carolina Neonatologists Association. Pediatrics 1999; 104 (6): 1345–1350.

    Article  CAS  Google Scholar 

  5. Palta M, Gabbert D, Weinstein MR, Peters ME . Multivariate assessment of traditional risk factors for chronic lung disease in very low birth weight neonates. The newborn lung project. J Pediatr 1991; 119 (2): 285–292.

    Article  CAS  Google Scholar 

  6. Shaffer SG, Bradt SK, Hall RT . Postnatal changes in total body water and extracellular volume in the preterm infant with respiratory distress syndrome. J Pediatr 1986; 109 (3): 509–514.

    Article  CAS  Google Scholar 

  7. Spitzer AR, Fox WW, Delivoria-Papadopoulos M . Maximum diuresis—a factor in predicting recovery from respiratory distress syndrome and the development of bronchopulmonary dysplasia. J Pediatr 1981; 98 (3): 476–479.

    Article  CAS  Google Scholar 

  8. Stevenson JG . Fluid administration in the association of patent ductus arteriosus complicating respiratory distress syndrome. J Pediatr 1977; 90 (2): 257–261.

    Article  CAS  Google Scholar 

  9. Tammela OK, Koivisto ME . Fluid restriction for preventing bronchopulmonary dysplasia? Reduced fluid intake during the first weeks of life improves the outcome of low-birth-weight infants. Acta Paediatr 1992; 81 (3): 207–212.

    Article  CAS  Google Scholar 

  10. Tooley WH . Epidemiology of bronchopulmonary dysplasia. J Pediatr 1979; 95 (5 Part 2): 851–858.

    Article  CAS  Google Scholar 

  11. Van Marter LJ, Leviton A, Allred EN, Pagano M, Kuban KC . Hydration during the first days of life and the risk of bronchopulmonary dysplasia in low birth weight infants. J Pediatr 1990; 116 (6): 942–949.

    Article  CAS  Google Scholar 

  12. Wadhawan R, Oh W, Perritt R, Laptook AR, Poole K, Wright LL et al. Association between early postnatal weight loss and death or BPD in small and appropriate for gestational age extremely low-birth-weight infants. J Perinatol 2007; 27 (6): 359–364.

    Article  CAS  Google Scholar 

  13. Aggarwal R, Deorari AK, Paul VK . Fluid and electrolyte management in term and preterm neonates. Indian J Pediatr 2001; 68 (12): 1139–1142.

    Article  CAS  Google Scholar 

  14. Baumgart S, Costarino AT . Water and electrolyte metabolism of the micropremie. Clin Perinatol 2000; 27 (1): 131–146, vi–vii.

    Article  CAS  Google Scholar 

  15. Costarino A, Baumgart S . Modern fluid and electrolyte management of the critically ill premature infant. Pediatr Clin N Am 1986; 33 (1): 153–178.

    Article  CAS  Google Scholar 

  16. Furzan JA, Reisch J, Tyson JE, Laird P, Rosenfeld CR . Incidence and risk factors for symptomatic patent ductus arteriosus among inborn very-low-birth-weight infants. Early Hum Dev 1985; 12 (1): 39–48.

    Article  CAS  Google Scholar 

  17. Mouzinho AI, Rosenfeld CR, Risser R . Symptomatic patent ductus arteriosus in very-low-birth-weight infants: 1987–1989. Early Hum Dev 1991; 27 (1–2): 65–77.

    Article  CAS  Google Scholar 

  18. Shaffer SG, Weismann DN . Fluid requirements in the preterm infant. Clin Perinatol 1992; 19 (1): 233–250.

    Article  CAS  Google Scholar 

  19. Hay Jr WW, Lucas A, Heird WC, Ziegler E, Levin E, Grave GD et al. Workshop summary: nutrition of the extremely low birth weight infant. Pediatrics 1999; 104 (6): 1360–1368.

    Article  Google Scholar 

  20. Thureen PJ . Early aggressive nutrition in the neonate. Pediatr Rev 1999; 20 (9): e45–e55.

    Article  CAS  Google Scholar 

  21. Shah PS . Current perspectives on the prevention and management of chronic lung disease in preterm infants. Paediatr Drugs 2003; 5 (7): 463–480.

    Article  Google Scholar 

  22. Sosenko IR, Frank L . Nutritional influences on lung development and protection against chronic lung disease. Semin Perinatol 1991; 15 (6): 462–468.

    CAS  PubMed  Google Scholar 

  23. American Academy of Pediatrics Committee on Nutrition. Nutritional needs of low-birth-weight infants. Pediatrics 1985; 75 (5): 976–986.

    Google Scholar 

  24. Richardson DK, Corcoran JD, Escobar GJ, Lee SK . SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr 2001; 138 (1): 92–100.

    Article  CAS  Google Scholar 

  25. Wu PY, Hodgman JE . Insensible water loss in preterm infants: changes with postnatal development and non-ionizing radiant energy. Pediatrics 1974; 54 (6): 704–712.

    CAS  PubMed  Google Scholar 

  26. American Academy of Pediatrics, Committee on Nutrition. Nutritional needs of the preterm infant. In: Fleinman, RE (ed.) Pediatric Nutrition Handbook, 5th edn. American Academy of Pediatrics: Elk Grove Village, 2004 pp 23–54.

  27. Spahr RC, Klein AM, Brown DR, Holzman IR, MacDonald HM . Fluid administration and bronchopulmonary dysplasia. The lack of an association. Am J Dis Child 1980; 134 (10): 958–960.

    Article  CAS  Google Scholar 

  28. Kavvadia V, Greenough A, Dimitriou G, Hooper R . Comparison of the effect of two fluid input regimens on perinatal lung function in ventilated infants of very low birthweight. Eur J Pediatr 1999; 158 (11): 917–922.

    Article  CAS  Google Scholar 

  29. Kavvadia V, Greenough A, Dimitriou G, Hooper R . Randomised trial of fluid restriction in ventilated very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 2000; 83 (2): F91–F96.

    Article  CAS  Google Scholar 

  30. Lorenz JM, Kleinman LI, Kotagal UR, Reller MD . Water balance in very low-birth-weight infants: relationship to water and sodium intake and effect on outcome. J Pediatr 1982; 101 (3): 423–432.

    Article  CAS  Google Scholar 

  31. Bell EF, Acarregui MJ . Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2001 (3): 1–13, CD000503.

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Correspondence to B E Stephens.

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Stephens, B., Gargus, R., Walden, R. et al. Fluid regimens in the first week of life may increase risk of patent ductus arteriosus in extremely low birth weight infants. J Perinatol 28, 123–128 (2008). https://doi.org/10.1038/sj.jp.7211895

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