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Postnatal maximal weight loss, fluid administration, and outcomes in extremely preterm newborns

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Abstract

Objective

Evaluate maximal weight loss (MWL) and total fluid administration (TFA) association in first week after birth with outcomes among extremely preterm (EP) newborns.

Study design

We performed a retrospective analysis of the Preterm Erythropoietin Neuroprotection Trial evaluating first-week MWL, TFA, and association with in-hospital outcomes.

Results

Among n = 883 included EP neonates, n = 842 survived ≥ 7 days and were included in outcome analyses. MWL between 5% to 15% was associated with decreased odds of necrotizing enterocolitis compared to MWL > 15% (OR 0.49, 95% CI 0.25–0.98). Average TFA > 150 mL/kg birthweight/day was associated with increased odds of necrotizing enterocolitis (OR 3.22, 95% CI 1.40–7.42) and patent ductus arteriosus requiring surgery (OR 2.14, 95% CI 1.10–4.15).

Conclusion

MWL between 5% to 15% is a potentially optimal window of MWL. Increasing average TFA in the first week is associated with adverse neonatal outcomes. Prospective studies evaluating MWL and TFA and relationship to outcomes in EP neonates are needed.

Clinical trial registration

This study is a secondary analysis of pre-existing data from the PENUT Trial Registration: NCT01378273, https://clinicaltrials.gov/ct2/show/NCT01378273.

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Fig. 1: Median and 10th–90th percentile weight loss trajectories after birth, depicted and analyzed by gestational age in all n = 883 infants.

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Acknowledgements

We would like to thank the PENUT Trial participants and the PENUT Trial primary investigator, co-investigators, research coordinators, University of Washington Data Coordinating Center, PENUT Executive Committee, Follow-up Committee, and Independent Medical Monitor. Please see Supplementary Material for a full list of names.

Funding

The PENUT trial was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award numbers U01NS077953 and U01NS077955.

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Author notes

  1. These authors contributed equally: Gregory C. Valentine, Krystle M. Perez.

Authors and Affiliations

  1. Division of Neonatology, University of Washington/Seattle Children’s Hospital, Seattle, WA, USA

    Gregory C. Valentine, Krystle M. Perez, Thomas R. Wood, Dennis E. Mayock, Mihai Puia-Dumitrescu & Sandra E. Juul

  2. Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine at Baylor College of Medicine, Houston, TX, USA

    Gregory C. Valentine

  3. Department of Biostatistics, University of Washington, Seattle, WA, USA

    Bryan A. Comstock & Patrick J. Heagerty

  4. Center on Human Development and Disability, University of Washington, Seattle, WA, USA

    Sandra E. Juul

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Contributions

GV and KP conceptualized the design of the secondary analysis, composed the initial draft of the manuscript, and revised its subsequent versions. TW performed the statistical analyses. TW, BC, DM, MP, PH and SJ were involved in revisions to the manuscript, and all agreed to the final draft of the manuscript being submitted.

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Correspondence to Gregory C. Valentine.

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Valentine, G.C., Perez, K.M., Wood, T.R. et al. Postnatal maximal weight loss, fluid administration, and outcomes in extremely preterm newborns. J Perinatol 42, 1008–1016 (2022). https://doi.org/10.1038/s41372-022-01369-7

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