Fluid administration in the association of patent ductus arteriosus complicating respiratory distress syndrome

doi:10.1016/S0022-3476(77)80645-8

The Journal of Pediatrics

Volume 90, Issue 2, February 1977, Pages 257-261

https://doi.org/10.1016/S0022-3476(77)80645-8 Get rights and content

Daily weights and mean daily fluid volumes administered to 62 infants with birth weights of less than 2,000 gm, who required respirator support for respiratory distress syndrome, were reviewed. In 31 infants signs of patent ductus arteriosus developed. In a comparison group of 31 infants, the mean daily fluid volume was 144 ml/kg/24 hours, and the mean body weight was 102% of expected, differing significantly from the 189 ml/kg/24 hours, and 114% of expected weight in those infants who developed PDA. Those infants who developed PDA had not differed significantly from the comparison group in either mean daily fluid volumes or expected weights prior to a period two days before clinical evidence of PDA. Seven infants developed PDA in association with increased fluid administration on more than one occasion during nursery stay. Diuresis after excessive fluid administration was associated with improvement in, or resolution of, signs of PDA in many infants. The results suggest that excessive fluid administration to premature infants with RDS may be one factor associated with the developed of PDA complicating RDS (PDA/RDS).

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However, this trial was conducted in larger infants born greater than 36 weeks and therefore we must be cautious in extrapolating these results to ELBW infants. Our finding of an association between infants with day 7 weight >birthweight and increased rates of PDA requiring treatment, aligns with the findings of several previous studies [12,20–22]. The presence of a hemodynamically significant PDA has been associated with various adverse short and long-term outcomes.
Weight gain in the first week of life is indicative of fluid excess in preterm neonates.
To determine if morbidity and/or mortality of extremely low birthweight (ELBW) infants was lower in those who did not have excess weight gain in the first week of life, compared with those who did.
Retrospective cohort study.
ELBW infants born from 1st May 2014 – 31st May 2019. Exclusions: major congenital abnormalities (including hydrops), died within the first 7 days, no recorded weight on day 6, 7 or 8.
We compared infants whose weight was greater than birthweight by day 7 and infants whose weight remained at, or below, birthweight by day 7.
There were 312 ELBW infants in the study population: 15 (5%) died before discharge from hospital. Holding birthweight and gestational age (GA) constant, the odds of death in neonates with day 7 weight >birthweight was about 3 times the odds of death in neonates with day 7 weight ≤birthweight (adjusted odds ratio 3.18, 95% confidence interval 0.66–15.26, p = 0.15). Neonates with day 7 weight >birthweight were more likely to have had a PDA that required treatment than those with day 7 weight ≤birthweight (65% versus 43% respectively; p <0.001).
ELBW infants who gain weight in the first week of postnatal life, have a greater risk of PDA requiring treatment and may have a higher risk of mortality than infants who lose weight in the first week of life.
The association of early postnatal weight loss with outcome in extremely low birth weight infants
2019, Pediatrics and Neonatology
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It has been proven that restricted water intake significantly increases postnatal weight loss and significantly reduces the risk of PDA.13 In different studies, a high volume of fluid intake is associated with PDA.15,16 In our study, there was no difference between the groups regarding to PDA.
To compare outcomes of extremely low birth weight (ELBW) infants having different weight losses in the first 3 days of life.
One hundred and twenty six ELBW infants were evaluated retrospectively for weight loss percentages on the third day of life compared to their birth weight. We examined the weight loss on the third day of life compared to the birth weight for the ELBW infants and tested its association with mortality and morbidities. The mortality was subgrouped as overall mortality and mortality in the first 7 days of life. The morbidities were patent ductus arteriosus (PDA), intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD). BPD was defined as need for supplemental oxygen at 36 weeks’ postconceptional age. We grouped the infants into four quartiles according to weight loss percentage on the third day of life: Group 1 (Quartile 1), infants with weight loss of 0–3% of birth weight; Group 2 (Quartile 2); infants with weight loss of 3.1–7.5%, Group 3 (Quartile 3), infants with weight loss of 7.51–12%; and Group 4 (Quartile 4), infants with weight loss of more than 12%. The mortality and morbidities were analyzed according to these groups and other risk factors.
Overall mortality and mortality in the first 7 days of life were significantly higher in Groups 1 (36% and 27%) and 4 (43% and 24%), compared to Groups 2 (10% and 10%) and 3 (18% and 9%), respectively.
Weight loss less than 3% and more than 12% was significantly associated with an increase in mortality. There was a positive correlation between weight loss on the third day of life and IVH.
Inappropriate weight loss in ELBW infants is associated with increased mortality and IVH. Appropriate weight loss can improve outcomes in this population.
First SIBEN clinical consensus: Diagnostic and therapeutic approach to patent ductus arteriosus in premature newborns
2008, Anales de Pediatria
Informar acerca del proceso y de los resultados del primer consenso clínico neonatal de la región iberoamericana.
Dos expertos reconocidos en el área (los Dres. Clyman y Van Overmeire) y 45 neonatólogos de 23 países fueron invitados a participar y a colaborar. Se desarrollaron 46 preguntas de importancia clínico-fisiológica sobre la totalidad de los aspectos del ductus arterioso permeable (DAP). Las pautas para el proceso del consenso, la búsqueda de la bibliografía y la futura preparación de material educativo y autoría fueron descritas, revisadas y acordadas por todos los participantes. Los expertos de diferentes países fueron distribuidos en grupos, y asignados para interactuar y trabajar conjuntamente para responder a las 3-5 preguntas, revisando la totalidad de la bibliografía globalmente y los factores locales. Las respuestas y los resúmenes fueron recibidos, cotejados y revisados por 2 coordinadores y los 2 expertos. Los participantes y los expertos se reunieron en Granada, España, durante 4,5 h (con conferencias de expertos, presentaciones por grupos y discusión de toda la bibliografía de la que se disponía).
Participaron 31 neonatólogos de 16 países. Las presentaciones de cada grupo y la discusión general se utilizaron para desarrollar un consenso en el que se consideraron: tratamiento general, disponibilidad de fármacos (indometacina frente a ibuprofeno), costes, indicaciones para eco/cirugía, etc. En este foro de cooperación, los participantes aprendieron numerosos aspectos del tratamiento de esta entidad.
Este primer grupo de consenso de neonatólogos iberoamericanos de SIBEN llevó a la participación activa y cooperativa de neonatolólogos de 16 países, mejoró la educación de todos los participantes y finalizó desarrollando un consenso sobre los enfoques clínicos del DAP. Además, indica recomendaciones para el cuidado clínico a las que se ha llegado mediante consenso. Asimismo, servirá como una base útil para futuros consensos de SIBEN en otros temas y podría llegar a ser un valioso modelo para disminuir la disparidad en el cuidado y mejorar los resultados en esta y en otras regiones.
To report the process and results of the first neonatal clinical consensus of the Ibero-American region.
Two recognized experts in the field (Clyman and Van Overmeire) and 45 neonatologists from 23 countries were invited for active participation and collaboration. We developed 46 questions of clinical-physiological relevance in all aspects of patent ductus arteriosus (PDA). Guidelines for consensus process, literature search and future preparation of educational material and authorship were developed, reviewed and agreed by all. Participants from different countries were distributed in groups, and assigned to interact and work together to answer 3-5 questions, reviewing all global literature and local factors. Answers and summaries were received, collated and reviewed by 2 coordinators and the 2 experts. Participants and experts met in Granada, Spain for 4.5 h (lectures by experts, presentations by groups, discussion, all literature available).
31 neonatologists from 16 countries agreed to participate. Presentations by each group and general discussion were used to develop a consensus regarding: general management, availability of drugs (indometacine vs. ibuprofen), costs, indications for echo/surgery, etc. Many steps were learnt by all present in a collaborative forum.
This first consensus group of Ibero-American neonatologists SIBEN led to active and collaborative participation of neonatologists of 16 countries, improved education of all participants and ended with consensus development on clinical approaches to PDA. Furthermore, it provides recommendations for clinical care reached by consensus. Additionally, it will serve as a useful foundation for future SIBEN Consensus on other topics and it could become valuable as a model to decrease disparity in care and improve outcomes in this and other regions.
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2008, Pediatric Respiratory Medicine
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2003, Seminars in Neonatology
Postnatal weight loss and contraction of the extracellular compartment is triggered by atrial natriuretic peptide
2000, Early Human Development
Following birth there is a contraction in the extracellular compartment, marked clinically by natriuresis, diuresis and weight loss. It is uncertain how these postnatal phenomena, which suggest an interrelationship with cardiopulmonary adaptation, are brought about. The aim of this study was to evaluate the temporal relationship between alterations in circulating atrial natriuretic peptide (ANP), respiratory status, sodium excretion and extracellular fluid volume (ECFV) in preterm babies, in the first days after birth. Eighteen male infants below 34 weeks gestational age were studied longitudinally, measuring urine output, sodium balance, arterial–alveolar oxygen ratio and circulating ANP. Daily changes in ECFV were assessed by endogenous chloride balance, following baseline measurement of bromide space. There was a clear period of improvement in respiratory function in 15 babies and in these there was a highly significant elevation in circulating ANP, either immediately prior to, or during, the period of improvement. In three infants there was no definable period of respiratory improvement. In four babies, two of whom had very mild respiratory distress, there was an immediate decline in ECFV after birth, in contrast to the remaining 14 infants, in whom there was an initial increase. This study demonstrates that there is a temporal relationship between improvement in respiratory function and an acute elevation in circulating ANP. Babies with respiratory distress syndrome are at risk of initial expansion of the extracellular compartment after birth. This is likely to increase morbidity. These observations are of relevance with regard to the clinical management of newborns with respiratory distress syndrome.

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Fluid administration in the association of patent ductus arteriosus complicating respiratory distress syndrome

J Pediatr

Patent ductus, prematurity and pulmonary disease

N Engl J Med

Commentary: Patent ductus arteriosus in premature infants—A diagnostic and therapeutic dilemma

J Pediatr

J Pediatr

Fluid administration in the association of patent ductus arteriosus complicating respiratory distress syndrome

Pediatr Res