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  • Quality Improvement Article
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Individualized fluid management in extremely preterm neonates to ensure adequate diuresis without increasing complications

Journal of Perinatology volume 41, pages 240–246 (2021)Cite this article

Subjects

Abstract

Objective

Decrease the incidence of inadequate diuresis (ID, loss of <6% of birth weight) in extremely preterm neonates (EPT, <28 weeks of gestation at birth) during the first week of life by 50% in 1 year.

Study design

Quality improvement project in a level IV neonatal intensive care unit. A fluid management protocol was implemented, including the use of a fluid guide sheet and closer monitoring of hydration parameters. Seventy-nine baseline EPT neonates were compared to 83 post intervention. The incidence of ID was tracked monthly, along with prespecified morbidities and complications. Statistical data analyses also compared the pre- and post-intervention periods.

Results

Fluid volumes in the first week were decreased (p < 0.001). ID decreased from 43 to 29% (p = 0.061). Tracked morbidities and complications were not statistically different.

Conclusion

Intentional and individualized adjustment of fluids led to decreased ID without increased hypernatremia and dehydration, or a change in tracked morbidities.

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Fig. 1: Key Driver Diagram.
Fig. 2: Incidence of inadequate diuresis in the first week of life, P-chart.

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Authors and Affiliations

  1. Vidant Medical Center, Greenville, NC, USA

    Jaclyn Havinga, Neha Hassan, Shannon Moore & Emma Dollhopf

  2. East Carolina University, Greenville, NC, USA

    Allison Williams, Dmitry Tumin & Uduak S. Akpan

Authors
  1. Jaclyn Havinga
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  2. Allison Williams
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  3. Neha Hassan
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  4. Shannon Moore
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  5. Emma Dollhopf
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  6. Dmitry Tumin
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  7. Uduak S. Akpan
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Contributions

JH: conceptualization and implementation of project, authorship of the discussion section, compiled the first draft of the paper, and critically reviewed the final paper, AW: conceptualization and implementation of project, authorship of the introduction, and revision of paper, NH: conceptualization and implementation of project, authorship of the discussion section, and revision of paper, SM: conceptualization and implementation of project, authorship of the methods section, and review of paper, ED: conceptualization and implementation of project, authorship of the introduction, and review of paper. DT: statistical analysis, authorship of the results section, and revision of paper. UA: conceptualization and implementation of project, authorship of the methods section, compiled the second draft of the paper, and revision of paper. JH and AW contributed equally to the conception and implementation of the project as well as authorship and are co-first authors.

Corresponding author

Correspondence to Jaclyn Havinga.

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The authors declare that they have no conflict of interest.

Ethical approval

The Institutional Review Board at our institution deemed this project exempt from review as it was considered a QI project.

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Havinga, J., Williams, A., Hassan, N. et al. Individualized fluid management in extremely preterm neonates to ensure adequate diuresis without increasing complications. J Perinatol 41, 240–246 (2021). https://doi.org/10.1038/s41372-020-00789-7

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  • DOI: https://doi.org/10.1038/s41372-020-00789-7

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