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Postnatal fluid balance – it’s time to pay attention

Journal of Perinatology volume 42, pages 985–986 (2022)Cite this article

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Fluid and electrolyte management is a critical aspect in the care of premature infants, particular in the first week after birth. The recently publication article by Valentine et al. builds upon over 40 years of literature examining associations between fluid balance and outcomes in preterm infants [1]. This secondary analysis of the Preterm Erythropoietin Neuroprotection Trial utilized a large cohort of infants born at <28 weeks of gestation to evaluate associations between maximal weight loss (MWL) and total fluid administration in the first week of life and relevant clinical outcomes [1, 2]. Their findings suggest MWL of 5–15% is optimal in the first 7 days after birth (compared to >15% MWL), being specifically associated with lower odds of necrotizing enterocolitis (NEC; aOR 0.49, 95% CI 0.25–0.98). Additionally, TFA > 150 ml/kg/day was associated with increased odds of NEC (aOR 3.22, 95% CI 1.40–7.42) and surgically treated patent ductus arteriosus (aOR 2.14, 95% CI 1.10–4.15).

During the immediate postnatal period, fluid balance in preterm infants is dynamic and complex. Total body water (TBW) decreases with advancing gestational age, accompanied by contraction of the extracellular space and expansion of the intracellular space (relative to total body weight). Thus, preterm infants have higher TBW and extracellular water at birth than term infants. Postnatal contraction of the extracellular space, resulting from urinary losses of sodium and water and insensible water losses, is therefore typically greater in preterm than term infants, resulting in a larger physiologic weight loss (expressed as percentage of birth weight). The success of this process is dependent not only on normal physiological factors, including maturational changes in neonatal kidney tubular function, but also on the volume of prescribed parenteral and enteral fluids.

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Authors and Affiliations

  1. Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA

    Heidi J. Steflik

  2. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA

    Jeffrey L. Segar

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  1. Heidi J. Steflik
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HJS and JLS together contributed to the concept and outline for this project, the collection of appropriate references, the interpretation of studies, and draft and revision of the manuscript. Both HJS and JLS approved the final submitted version and agree to be accountable for all aspects of the work.

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Correspondence to Heidi J. Steflik.

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Steflik, H.J., Segar, J.L. Postnatal fluid balance – it’s time to pay attention. J Perinatol 42, 985–986 (2022). https://doi.org/10.1038/s41372-022-01442-1

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