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Association between fluid overload and mortality in newborns: a systematic review and meta-analysis

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Abstract

Fluid overload (FO) is associated with higher rates of mortality and morbidity in pediatric and adult populations. The aim of this systematic review and meta-analysis was to investigate the association between FO and mortality in critically ill neonates. Systematic search of Ovid MEDLINE, EMBASE, Cochrane Library, trial registries, and gray literature from inception to January 2021. We included all studies that examined neonates admitted to neonatal intensive care units and described FO and outcomes of interest. We identified 17 observational studies with a total of 4772 critically ill neonates who met the inclusion criteria. FO was associated with higher mortality (OR, 4.95 [95% CI, 2.26–10.87]), and survivors had a lower percentage of FO compared with nonsurvivors (WMD, − 4.33 [95% CI, − 8.34 to − 0.32]). Neonates who did not develop acute kidney injury (AKI) had lower FO compared with AKI patients (WMD, − 2.29 [95% CI, − 4.47 to − 0.10]). Neonates who did not require mechanical ventilation on postnatal day 7 had lower fluid balance (WMD, − 1.54 [95% CI, − 2.21 to − 0.88]). FO is associated with higher mortality, AKI, and need for mechanical ventilation in critically ill neonates in the intensive care unit. Strict control of fluid balance to prevent FO is essential.

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References

  1. Lopes CLS, Piva JP (2017) Fluid overload in children undergoing mechanical ventilation. Rev Bras Ter Intensiva 29:346–353

    Article  Google Scholar 

  2. Stritzke A, Thomas S, Amin H, Fusch C, Lodha A (2017) Renal consequences of preterm birth. Mol Cell Pediatr 4:2. https://doi.org/10.1186/s40348-016-0068-0

    Article  PubMed  PubMed Central  Google Scholar 

  3. Murphy CV, Schramm GE, Doherty JA, Reichley RM, Gajic O, Afessa B, Micek ST, Kollef MH (2009) The importance of fluid management in acute lung injury secondary to septic shock. Chest 136:102–109

    Article  Google Scholar 

  4. Claure-Del Granado R, Mehta RL (2016) Fluid overload in the ICU: evaluation and management. BMC Nephrol 17:109

    Article  Google Scholar 

  5. Ogbu OC, Murphy DJ, Martin GS (2015) How to avoid fluid overload. Curr Opin Crit Care 21:315–321

    Article  Google Scholar 

  6. Sakr Y, Vincent JL, Reinhart K, Groeneveld J, Michalopoulos A, Sprung CL, Artigas A, Ranieri VM (2005) High tidal volume and positive fluid balance are associated with worse outcome in acute lung injury. Chest 128:3098–3108

    Article  Google Scholar 

  7. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL (2005) Comparison of Two Fluid-Management Strategies in Acute Lung Injury. N Engl J Med 51(229):230

    Google Scholar 

  8. Sakr Y, Rubatto Birri PN, Kotfis K, Nanchal R, Shah B, Kluge S, Schroeder ME, Marshall JC, Vincent JL (2017) Higher fluid balance increases the risk of death from sepsis: results from a large international audit∗. Crit Care Med 45:386–394

    Article  Google Scholar 

  9. Messmer AS, Zingg C, Müller M, Gerber JL, Schefold JC, Pfortmueller CA (2020) Fluid Overload and Mortality in Adult Critical Care Patients-A Systematic Review and Meta-Analysis of Observational Studies. Crit Care Med 48:1862–1870

    Article  Google Scholar 

  10. Alobaidi R, Morgan C, Basu RK, Stenson E, Featherstone R, Majumdar SR, Bagshaw SM (2018) Association between fluid balance and outcomes in critically ill children: a systematic review and meta-analysis. JAMA Pediatr 172:257–268

    Article  Google Scholar 

  11. Selewski DT, Akcan-Arikan A, Bonachea EM, Gist KM, Goldstein SL, Hanna M, Joseph C, Mahan JD, Nada A, Nathan AT, Reidy K, Staples A, Wintermark P, Boohaker LJ, Griffin T, Askenazi DJ, Guillet R (2018) The impact of fluid balance on outcomes in critically ill near-term/term neonates: a report from the AWAKEN study group. Pediatr Res 85:79–85

  12. Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA (2015) Preferred reporting items for systematic review and meta-analysis protocols (prisma-p) 2015: Elaboration and explanation. BMJ 349:1–25

    Article  Google Scholar 

  13. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021). Cochrane, 2021. Available from https://www.training.cochrane.org/handbook.

  14. McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C (2016) PRESS Peer Review of Electronic Search Strategies: 2015 Guideline Statement. J Clin Epidemiol 75:40–46

    Article  Google Scholar 

  15. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A (2016) Rayyan-a web and mobile app for systematic reviews. Syst Rev 5:210

    Article  Google Scholar 

  16. GA Wells, B Shea, D O'Connell, J Peterson, V Welch, M Losos, P Tugwell. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Published 2000. Accessed 1 Jan 2021

  17. Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:135

    Article  Google Scholar 

  18. Ueno K, Shiokawa N, Takahashi Y, Nakae K, Kawamura J, Imoto Y, Kawano Y (2019) Kidney disease: improving global outcomes in neonates with acute kidney injury after cardiac surgery. Clin Exp Nephrol 24:167–173

    Article  Google Scholar 

  19. Matsushita FY, Krebs VLJ, Ferraro AA, de Carvalho WB (2020) Early fluid overload is associated with mortality and prolonged mechanical ventilation in extremely low birth weight infants. Eur J Pediatr 179:1665–1671

    Article  Google Scholar 

  20. Rallis D, Drougia A, Balomenou F, Fintzou M, Benekos T, Vlahos A, Giapros V (2019) The association of fluid overload during the first postnatal day with patent ductus arteriosus and bronchopulmonary dysplasia in preterm infants. Eur J Pediatr 178:1733–1734

    Google Scholar 

  21. Stojanović V, Bukarica S, Antić J, Doronjski A (2017) Peritoneal dialysis in very low birth weight neonates. J Matern Neonatal Med 29:283–284

    Google Scholar 

  22. Noh ES, Kim HH, Kim HS, Han YS, Yang M, Ahn SY, Sung SI, Chang YS, Park WS (2019) Continuous Renal Replacement Therapy in Preterm Infants. Yonsei Med J 60:984–991

    Article  Google Scholar 

  23. Askenazi DJ, Koralkar R, Hundley HE, Montesanti A, Patil N, Ambalavanan N (2013) Fluid overload and mortality are associated with acute kidney injury in sick near-term/term neonate. Pediatr Nephrol 28:661–666

    Article  Google Scholar 

  24. Selewski DT, Gist KM, Nathan AT, Goldstein SL et al (2020) The impact of fluid balance on outcomes in premature neonates: a report from the AWAKEN study group. Pediatr Res 87:550–557

    Article  CAS  Google Scholar 

  25. Wilder NS, Yu S, Donohue JE, Goldberg CS, Blatt NB (2016) Fluid overload is associated with late poor outcomes in neonates following cardiac surgery. Pediatr Crit Care Med 17:420–427

    Article  Google Scholar 

  26. Mah KE, Hao S, Sutherland SM, Kwiatkowski DM, Axelrod DM, Almond CS, Krawczeski CD, Shin AY (2017) Fluid overload independent of acute kidney injury predicts poor outcomes in neonates following congenital heart surgery. Pediatr Nephrol 33:511–520

    Article  Google Scholar 

  27. Lee HJ, Lee BS, Do H-J, Oh S-H, Choi Y-S, Chung S-H, Kim EA-R, Kim K-S (2015) Early sodium and fluid intake and severe intraventricular hemorrhage in extremely low birth weight infants. J Korean Med Sci 30:283–289

    Article  CAS  Google Scholar 

  28. Lee ST, Cho H (2016) Fluid overload and outcomes in neonates receiving continuous renal replacement therapy. Pediatr Nephrol 31:2145–2152

    Article  Google Scholar 

  29. Adcock B, Carpenter S, Bauer J, Giannone P, Schadler A, Chishti A, Hanna M (2020) Acute kidney injury, fluid balance and risks of intraventricular hemorrhage in premature infants. J Perinatol 40:1296–1300

    Article  Google Scholar 

  30. Guo MM-H, Chung C-H, Chen F-S, Chen C-C, Huang H-C, Chung M-Y (2015) Severe bronchopulmonary dysplasia is associated with higher fluid intake in very low-birth-weight infants: a retrospective study. Am J Perinatol 30:155–162

    Article  Google Scholar 

  31. Piggott KD, Soni M, Decampli WM, Ramirez JA, Holbein D, Fakioglu H, Blanco CJ, Pourmoghadam KK (2015) Acute kidney injury and fluid overload in neonates following surgery for congenital heart disease. World J Pediatr Congenit Heart Surg 6:401–406

    Article  Google Scholar 

  32. Yum SK, Sung HJ, Sung IK (2019) Risk factors associated with acute kidney injury after bedside open laparotomy in neonates. Crit Care Med 47:712. https://doi.org/10.1097/01.ccm.0000552215.59880.6c

    Article  Google Scholar 

  33. Oh W, Poindexter BB, Perritt R, Lemons JA, Bauer CR, Ehrenkranz RA, Stoll BJ, Poole K, Wright LL (2005) Association between fluid intake and weight loss during the first ten days of life and risk of bronchopulmonary dysplasia in extremely low birth weight infants. J Pediatr 147:786–790

    Article  Google Scholar 

  34. Jetton JG, Boohaker LJ, Sethi SK, Wazir S et al (2017) Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child Adolesc Health 1:184–194

    Article  Google Scholar 

  35. Mehta RL, Kellum JA, Shah SV, Molitoris BA et al (2007) Acute kidney injury network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 11:R31

    Article  Google Scholar 

  36. Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL (2007) Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 71:1028–1035

    Article  CAS  Google Scholar 

  37. Kreimeier U (2000) Pathophysiology of fluid imbalance. Crit Care 4(Suppl 2):S3-7

    Article  Google Scholar 

  38. Marx G, Vangerow B, Burczyk C, Gratz KF, Maassen N, Cobas Meyer M, Leuwer M, Kuse E, Rueckoldt H (2000) Evaluation of noninvasive determinants for capillary leakage syndrome in septic shock patients. Intensive Care Med 26:1252–1258

    Article  CAS  Google Scholar 

  39. Sánchez M, Jiménez-Lendínez M, Cidoncha M, Asensio MJ, Herrero E, Collado A, Santacruz M (2011) Comparison of fluid compartments and fluid responsiveness in septic and non-septic patients. Anaesth Intensive Care 39:1022–1029

    Article  Google Scholar 

  40. Yerram P, Karuparthi PR, Misra M (2010) Fluid overload and acute kidney injury. Hemodial Int 14:348–354

    Article  Google Scholar 

  41. Flori HR, Church G, Liu KD, Gildengorin G, Matthay MA (2011) Positive fluid balance is associated with higher mortality and prolonged mechanical ventilation in pediatric patients with acute lung injury. Crit Care Res Pract 2011:854142

    PubMed  PubMed Central  Google Scholar 

  42. Ostermann M, van Straaten HMO, Forni LG (2015) Fluid overload and acute kidney injury: cause or consequence? Crit Care 19:19–21

    Article  Google Scholar 

  43. Wang N, Jiang L, Zhu B, Wen Y, Xi XM (2015) Fluid balance and mortality in critically ill patients with acute kidney injury: a multicenter prospective epidemiological study. Crit Care 19:371

    Article  Google Scholar 

  44. Kavvadia V, Greenough A, Dimitriou G, Hooper R (2000) Randomised trial of fluid restriction in ventilated very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 83:5–10

    Article  Google Scholar 

  45. Tanigasalam V, Plakkal N, Vishnu Bhat B, Chinnakali P (2018) Does fluid restriction improve outcomes in infants with hypoxic ischemic encephalopathy? A pilot randomized controlled trial. J Perinatol 38:1512–1517

    Article  Google Scholar 

  46. Gupta N, Bruschettini M, Chawla D (2021) Fluid restriction in the management of transient tachypnea of the newborn. Cochrane Database Syst Rev 2:CD011466. https://doi.org/10.1002/14651858.CD011466.pub2

    Article  PubMed  Google Scholar 

  47. Barrington KJ, Fortin-Pellerin E, Pennaforte T (2017) Fluid restriction for treatment of preterm infants with chronic lung disease. Cochrane Database Syst Rev 2:CD005389. https://doi.org/10.1002/14651858.CD005389.pub2

    Article  PubMed  Google Scholar 

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Acknowledgements

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 & 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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Contributions

F.Y.M., V.L.J.K, and W.B.C conceptualized and designed the study and reviewed and revised the manuscript. F.Y.M. and V.L.J.K collected data, carried out statistical analysis, interpreted the data, and drafted the initial manuscript. All authors approved the final manuscript.

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Correspondence to Felipe Yu Matsushita.

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The authors declare that they have no conflict of interest.

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Because this is a meta-analysis, patient consent was not required.

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Impact

• Fluid overload is associated with higher mortality rate, acute kidney injury, and mechanical ventilation necessity in newborns.

• This is the first systematic review and meta-analysis to analyze the association between fluid overload and outcomes in newborns.

• More careful attention to fluid balance control in neonates is needed.

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Matsushita, F.Y., Krebs, V.L.J. & de Carvalho, W.B. Association between fluid overload and mortality in newborns: a systematic review and meta-analysis. Pediatr Nephrol 37, 983–992 (2022). https://doi.org/10.1007/s00467-021-05281-8

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