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Fluid restriction in management of patent ductus arteriosus in Italy: a nationwide survey

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A Correspondence to this article was published on 01 December 2022

Abstract

We aimed at establishing the state of the art in fluid restriction practice in our national setting and providing a foundation for future research efforts. A prospective cross-sectional survey was conducted among all 114 Italian Neonatal Units in order to address conservative management of patent ductus arteriosus (PDA) in preterm infants below 29 weeks’ gestational age (GA), with specific regard to fluid restriction. Response rate was 80%. Conservative measures for PDA management are provided in the majority of NICUs and 80% of centers reduce fluid intake in neonates with PDA. No relationship can be found among pharmacologically or surgically treated patients per year and the approach to fluid restriction. The minimum intake administered at regimen when fluid restriction is applied is associated to the ratio between the maximum number of neonates managed pharmacologically and number of admitted < 29 weeks’ GA newborns.

Conclusion: Our survey shows an extreme variability among centers in terms of use of fluid restriction as a prophylactic tool but also in terms of its use (both opportunity and modality) when a hemodynamically significant PDA is diagnosed. This variability, that can be also found in randomized trials and observational studies, suggests that further evidence is needed to better understand its potential beneficial effects and its potential harms such as dehydration, hypotension, decreased end-organ perfusion, and reduced caloric intake.

What is Known:

• The lack of demonstrable improvement following the treatment of patent ductus arteriosus has recently paved the way to a more conservative approach.

• Fluid restriction is the most commonly applied conservative treatment of PDA.

What is New:

• Among Italian NICUs an extreme variability in terms of indications, timing and modalities of application of Fluid restriction can be found.

• This variability reflects the lack of standardization of this practice and the contrasting evidence on its efficacy.

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Abbreviations

BPD:

Bronchopulmonary dysplasia

DOL:

Day of life

ELBW:

Extremely low birthweight

FO:

Fluid overload

FR:

Fluid restriction

GA:

Gestational age

HSPDA:

Hemodynamically significant patent ductus arteriosus

ISGNC:

The Italian Study Group of Neonatal Cardiology

ISN:

Italian Society of Neonatology

IVH:

Intraventricular hemorrhage

NEC:

Necrotizing enterocolitis

NICU:

Neonatal intensive care unit

OR:

Odds ratio

PEEP:

Positive end expiratory pressure

PDA:

Patent ductus arteriosus

PVL:

Periventricular leukomalacia

RCT:

Randomized controlled trial

VLBWI:

Very low birthweight infants

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Author information

Authors and Affiliations

  1. NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Gaia Francescato

  2. Neonatal Intensive Care Unit, Ospedale Pediatrico Bambino Gesù, Rome, Italy

    Irma Capolupo

  3. Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    Rosa Maria Cerbo

  4. Neonatal Intensive Care Unit FMBBM San Gerardo, Monza, Italy

    Daniela Doni

  5. Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy

    Benjamim Ficial

  6. Department of Neonatology, Valduce Hospital, Como, Italy

    Stefano Fiocchi

  7. Neonatal Intensive Care Unit, Villa Sofia-Cervello Hospital, Palermo, Italy

    Federico Matina

  8. Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Gregorio Paolo Milani

  9. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Gregorio Paolo Milani

  10. Division of Neonatology and NICU San Camillo-Forlanini Hospital, Rome, Italy

    Fabio Mizzoni

  11. Neonatal Intensive Care Unit, Azienda Ospedaliera-Università di Padova, Padova, Italy

    Sabrina Salvadori

  12. Neonatal Intensive Care Unit, S Maria Della Misericordia Hospital, Udine, Italy

    Marilena Savoia

  13. Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy

    Iuri Corsini

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  1. Gaia Francescato
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Contributions

Gaia Francescato, Iuri Corsini, Benjamim Ficial, Rosamaria Cerbo, Stefano Fiocchi, Marilena Savoia, and Sabrina Salvadori contributed to study conception and design. Material preparation, data collection, and analysis were performed by Gaia Francescato, Iuri Corsini, Federico Matina, Fabio Mizzoni, Daniela Doni, Irma Capolupo, and Gregorio Milani. The first draft of the manuscript was written by Gaia Francescato, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Gaia Francescato.

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Communicated by Daniele De Luca

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Francescato, G., Capolupo, I., Cerbo, R.M. et al. Fluid restriction in management of patent ductus arteriosus in Italy: a nationwide survey. Eur J Pediatr 182, 393–401 (2023). https://doi.org/10.1007/s00431-022-04685-4

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