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Early fluid overload is associated with mortality and prolonged mechanical ventilation in extremely low birth weight infants

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Abstract

Recent studies revealed that fluid overload is associated with higher mortality in critically ill children and adults. This study aimed to evaluate the association between fluid overload in the first 3 days of life and mortality in extremely low birth weight infants. This single-center retrospective cohort study included two hundred nineteen newborns with birth weight less than 1000 g who were admitted to the neonatal intensive care between January 2012 and December 2017. Overall mortality was 32.4%, the median gestational age was 27.3 (26.1–29.4) weeks, and birth weight was 770 (610–900) grams. In the group with severe fluid overload, we found a higher rate of deaths (72.2%); mean airway pressure was significantly higher and with longer invasive mechanical ventilation necessity.

Conclusion: Early fluid overload in extremely low birth weight infants is associated with higher mortality rate, higher mean airway pressure in invasive mechanically ventilated patients, and longer mechanical ventilation duration in the first 7 days of life.

What is Known:

• Fluid overload is associated with a higher mortality rate and prolonged mechanical ventilation in children and adults.

What is New:

• Fluid overload in the first 72 h of life in an extremely premature infant is associated with higher mortality rate, higher mean airway pressure in invasive mechanically ventilated patients, and longer mechanical ventilation duration the first 7 days of life.

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Abbreviations

CI:

Confidence interval

CRIB II:

Clinical Risk Index for Babies

G:

Grams

MAP:

Mean airway pressure

mL:

Milliliter

NICU:

Neonatal intensive care unit

OR:

Odds ratio

SD:

Standard deviation

Wk:

Weeks

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Acknowledgments

We thank all the colleagues at the NICU staff at the Faculty of Medicine of the University of São Paulo.

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Authors and Affiliations

  1. Department of Pediatrics, Neonatology Division, Faculty of Medicine of the University of São Paulo, Instituto da Criança, Av. Dr. Enéas de Carvalho Aguiar 647, São Paulo, SP, 05403-000, Brazil

    Felipe Yu Matsushita, Vera Lúcia Jornada Krebs, Alexandre Archanjo Ferraro & Werther Brunow de Carvalho

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  1. Felipe Yu Matsushita
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  2. Vera Lúcia Jornada Krebs
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  3. Alexandre Archanjo Ferraro
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  4. Werther Brunow de Carvalho
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Contributions

FYM developed the theory, contributed to the design and implementation of the research, and led data acquisition and to the analysis of the results and to the writing of the manuscript. AAF contributed with the statistical analysis. VLJK and WBC contributed to the design and implementation of the research and revised the manuscript. All authors approved the final manuscript as submitted.

Corresponding author

Correspondence to Werther Brunow de Carvalho.

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The authors declare that they have no conflict of interest.

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Communicated by Daniele De Luca

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Matsushita, F.Y., Krebs, V.L.J., Ferraro, A.A. et al. Early fluid overload is associated with mortality and prolonged mechanical ventilation in extremely low birth weight infants. Eur J Pediatr 179, 1665–1671 (2020). https://doi.org/10.1007/s00431-020-03654-z

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  • DOI: https://doi.org/10.1007/s00431-020-03654-z

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