Elsevier

The Journal of Pediatrics

Volume 147, Issue 6, December 2005, Pages 786-790
The Journal of Pediatrics

Original Article
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

https://doi.org/10.1016/j.jpeds.2005.06.039Get rights and content

Objective

To demonstrate the association between fluid intake and weight loss during the first 10 days of life and the risk of bronchopulmonary dysplasia (BPD) in extremely low birth weight (ELBW) infants.

Study design

A retrospective analysis of data from a cohort of ELBW infants enrolled in the Neonatal Research; 1,382 infants with birth weight between 401 and 1,000 g were randomized. The daily fluid intake and weight loss during the first 10 days of life were compared between the infants who survived without BPD and those who either died or developed BPD. Demographic and clinical neonatal variables were also compared. Multivariate logistic regression was used to analyze the effect of fluid intake and weight loss on death or BPD, controlling for demographic and clinical factors that are significantly associated with BPD by univariate analysis.

Results

585 infants survived without BPD and 797 infants either died or developed BPD. Univariate analysis showed that the daily fluid intakes were higher (day 2-10) and weight loss less (day 6-9) in the group of infants who either died or developed BPD. In addition, lower birth weight, lower gestational age, male gender, lower 1 and 5-minute Apgar Scores, higher oxygen requirement at 24 hours of age, longer duration of assisted ventilation, use of postnatal steroids for BPD and presence of severe intraventricular hemorrhage, proven necrotizing enterocolitis, patent ductus arteriosus, and late onset sepsis, were associated with higher incidence of death or BPD. The adjusted risk of higher fluid intake and less weight loss during the first 10 days of life remained significantly related to death or BPD.

Conclusion

In this cohort of ELBW infants treated during the post surfactant era, higher fluid intake and less weight loss during the first 10 days of life were associated with an increased risk of BPD. The finding suggests that careful attention to fluid balance might be an important means to reduce the incidence of BPD.

Section snippets

Methods

The Neonatal Research Network recently completed a randomized controlled trial (October,1999-August,2001) to evaluate the efficacy of parenteral glutamine supplementation to reduce the incidence of late onset sepsis in ELBW infants who survived beyond the first 12 hours of life.15 During the course of the trial, the data on daily fluid intake and weight changes of study subjects were collected prospectively. Mortality and incidence of BPD were also documented.

A total of 1433 infants weighing

Results

Of the 1,382 infants in the study cohort, 58% (n = 797) either died (n = 224) or developed BPD (n = 573), while 42% survived without BPD (n = 585). Compared to survivors without BPD, infants who died or developed BPD had significantly lower birth weight and gestational age, more male infants, lower 1 and 5-minute Apgar scores, higher FiO2 requirement at 24 hours of age,longer duration of assisted ventilation, more use of postnatal steroids for BPD and higher incidence of severe IVH, proven NEC,

Discussion

This retrospective analysis of prospectively collected data confirmed our hypothesis that higher fluid intake and lack of postnatal weight loss during the immediate postnatal period predisposed this high-risk group of infants to BPD. Death was included as a primary outcome because it is a competing outcome with BPD. There was a concern that including death as variable may include those infants who died because of physicians' decision to withdraw care due to extreme immaturity and serious

References (23)

  • B. Friis-Hansen

    Body water compartment in children: Changes during growth and related changes in body composition

    Pediatrics

    (1961)
  • Cited by (0)

    Supported by Grant support: This study is supported by the following grants: HD U10 21397, HD U10 27871, HD U10 27904, HD U10 27851, HD U10 27856, HD U10 36790.

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