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Positive fluid balance and diuretic therapy are associated with mechanical ventilation and mortality in preterm neonates in the first fourteen postnatal days

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Abstract

Background

Fluid overload leads to poor neonatal outcomes. Diuretics may lower the rates of mechanical ventilation (MV) and mortality in neonates with fluid overload.

Methods

This is a retrospective study of preterm neonates ≤ 36 weeks of gestational age (GA) in the first 14 postnatal days in a level IV NICU in 2014–2020. We evaluated the epidemiology of fluid balance in the first 14 postnatal days and its association with MV and mortality and studied the association of diuretics with fluid balance, MV, and mortality.

Results

In 1383 included neonates, the overall median lowest and peak fluid balances were − 7.8% (IQR: − 11.7, − 4.6) and 8% (3, 16) on days 3 (2, 5) and 13 (5, 14), respectively. Fluid balance distribution varied significantly by GA. Peak fluid balance of ≥ 10% was associated with increased odds of MV on days 7 and 14 with highest odds ratios (OR) of MV in neonates with fluid balance ≥ 15%. Peak fluid balance of ≥ 15% was associated with the greatest odds of mortality. Diuretics were used more frequently in neonates with younger GA, smaller birthweight, positive fluid balance, and those on MV.

Conclusions

Positive fluid balance negatively impacts pulmonary status. The odds of MV and death increase significantly as peak fluid balance percentage increases in all GA groups. The impact of diuretics on MV and death in preterm neonates needs further evaluation.

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Data availability

All relevant raw data are freely available.

Code availability

Not applicable.

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Funding

This work is supported by internal funding from the Abigail Wexner Research Institute at Nationwide Children’s Hospital.

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Authors and Affiliations

  1. Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH, USA

    Mariah L. Wright, Elizabeth Bonachea, John D. Spencer, Jonathan L. Slaughter & Tahagod H. Mohamed

  2. Division of Nephrology and Hypertension, Nationwide Children’s Hospital, Columbus, OH, USA

    Brett G. Klamer, John D. Spencer & Tahagod H. Mohamed

  3. The Kidney and Urinary Tract Center, Nationwide Children’s Hospital, Columbus, OH, USA

    Brett G. Klamer, John D. Spencer & Tahagod H. Mohamed

  4. Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, USA

    Brett G. Klamer

  5. The Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA

    Jonathan L. Slaughter

  6. Division of Epidemiology, College of Public Health, The Ohio State University College of Medicine, Columbus, OH, USA

    Jonathan L. Slaughter

Authors
  1. Mariah L. Wright
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  2. Brett G. Klamer
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  3. Elizabeth Bonachea
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  4. John D. Spencer
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  5. Jonathan L. Slaughter
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  6. Tahagod H. Mohamed
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Contributions

THM conceptualized and designed the study, collected data, analyzed the data, and reviewed and revised the manuscript. MLW collected data, analyzed the data, assisted with the study design, and reviewed and revised the manuscript. THM and MLW contributed equally to the initial draft of the manuscript and provided revisions. BK carried out the analysis, designed tables and figures, and reviewed and revised the manuscript for important intellectual content. EB, JDS, and JLS assisted with the study design, analyzed the data, and reviewed and revised the manuscript.

Corresponding author

Correspondence to Tahagod H. Mohamed.

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The Nationwide Children’s Hospital Institutional Review Board determined that this study is exempt.

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The authors declare no competing interests.

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Wright, M.L., Klamer, B.G., Bonachea, E. et al. Positive fluid balance and diuretic therapy are associated with mechanical ventilation and mortality in preterm neonates in the first fourteen postnatal days. Pediatr Nephrol 38, 2243–2253 (2023). https://doi.org/10.1007/s00467-022-05861-2

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  • DOI: https://doi.org/10.1007/s00467-022-05861-2

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