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Positive fluid balance is associated with death and severity of brain injury in neonates with hypoxic–ischemic encephalopathy

Journal of Perinatology volume 41, pages 1331–1338 (2021)Cite this article

Subjects

Abstract

Objective

To investigate the association between fluid balance during therapeutic hypothermia (TH) and severity of brain injury on magnetic resonance imaging (MRI) in neonates with hypoxic–ischemic encephalopathy (HIE).

Study design

This is a secondary analysis of data from a prospective observational study in neonates with HIE. Daily net positive fluid balance during TH was investigated for association with the adverse primary outcome of death or moderate-to-severe brain injury on MRI using multivariable logistic regression.

Results

Of the 150 neonates included, 50 suffered adverse outcome and had significantly higher net positive fluid balance (53 vs. 19 ml/kg/day, p < 0.01) during first 24 hours of TH. Neonates with a net positive fluid balance (>25 ml/kg/day) at 24 hours of TH had 3.4 (95% CI 1.3–9) times higher odds of adverse outcome.

Conclusions

Positive fluid balance during TH in neonates with HIE is independently associated with death or moderate-to-severe brain injury on MRI.

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Acknowledgements

We thank the many technicians, nurses, physicians, and scientists at the Children’s National Hospital Neonatal Intensive Care Unit who contributed to the development and implementation of the original prospective study, and the families of participating infants.

Funding

This study was supported by the Clinical and Translational Science Institute at Children’s National (UL1TR000075, 1KL2RR031987-01) and the National Institutes of Health Intellectual and Developmental Disabilities Research Consortium (U54 HD090257).

Author information

Author notes

  1. Katherine M. Ottolini

    Present address: Department of Neonatology, 18th Healthcare Operations Squadron, Kadena AB, Okinawa, Japan

  2. Katherine M. Ottolini

    Present address: Department of Pediatrics, Division of Neonatology, Uniformed Services University, Bethesda, MD, USA

  3. These authors contributed equally: Katherine M. Ottolini, Sudeepta K. Basu

Authors and Affiliations

  1. Division of Neonatology, Children’s National Hospital, Washington, DC, USA

    Katherine M. Ottolini, Sudeepta K. Basu, Suleiman Mashat, Michelande Ridore & An N. Massaro

  2. Department of Pediatrics, The George Washington University School of Medicine, Washington, DC, USA

    Sudeepta K. Basu, Gilbert Vezina, James Bost, Taeun Chang & An N. Massaro

  3. Division of Biostatistics and Study Methodology, Children’s National Hospital, Washington, DC, USA

    Nicole Herrera & James Bost

  4. Division of Fetal and Transitional Medicine, Children’s National Hospital, Washington, DC, USA

    Vedavalli Govindan

  5. Division of Diagnostic Imaging and Radiology, Children’s National Hospital, Washington, DC, USA

    Gilbert Vezina

  6. Division of Epilepsy, Neurophysiology & Critical Care, Children’s National Hospital, Washington, DC, USA

    Taeun Chang

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Contributions

KMO conceptualized and designed the study, drafted the initial manuscript, and approved the final manuscript as submitted. SKB conceptualized and designed the study, performed statistical analysis, drafted the initial manuscript, and approved the final manuscript as submitted. MR conceptualized and designed the study, reviewed and revised the initial manuscript, and approved the final manuscript as submitted. SM and VG performed data collection, reviewed and revised the initial manuscript, and approved the final manuscript as submitted. GV performed the radiologic classification of MRIs according to the Barkovich criteria, reviewed and revised the initial manuscript, and approved the final manuscript as submitted. NH performed statistical analysis, summarized results, critically reviewed the manuscript, and approved the final manuscript as submitted. JB supervised statistical analysis, summarized results, critically reviewed the manuscript, and approved the final manuscript as submitted. TC conceptualized and designed the study, reviewed and revised the manuscript, and approved the final manuscript as submitted. ANM conceptualized and designed the study, supervised data analysis and interpretation, reviewed and revised the manuscript, and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to An N. Massaro.

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The authors have no potential conflicts of interest to disclose. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health Intellectual and Developmental Disabilities Research Consortium or the United States Air Force.

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Ottolini, K.M., Basu, S.K., Herrera, N. et al. Positive fluid balance is associated with death and severity of brain injury in neonates with hypoxic–ischemic encephalopathy. J Perinatol 41, 1331–1338 (2021). https://doi.org/10.1038/s41372-021-00988-w

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