Early fluid overload is associated with mortality and prolonged mechanical ventilation in extremely low birth weight inf
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ORIGINAL ARTICLE
Early fluid overload is associated with mortality and prolonged mechanical ventilation in extremely low birth weight infants Felipe Yu Matsushita 1 & Vera Lúcia Jornada Krebs 1 & Alexandre Archanjo Ferraro 1 & Werther Brunow de Carvalho 1 Received: 16 January 2020 / Revised: 13 April 2020 / Accepted: 16 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Recent studies revealed that fluid overload is associated with higher mortality in critically ill children and adults. This study aimed to evaluate the association between fluid overload in the first 3 days of life and mortality in extremely low birth weight infants. This single-center retrospective cohort study included two hundred nineteen newborns with birth weight less than 1000 g who were admitted to the neonatal intensive care between January 2012 and December 2017. Overall mortality was 32.4%, the median gestational age was 27.3 (26.1–29.4) weeks, and birth weight was 770 (610–900) grams. In the group with severe fluid overload, we found a higher rate of deaths (72.2%); mean airway pressure was significantly higher and with longer invasive mechanical ventilation necessity. Conclusion: Early fluid overload in extremely low birth weight infants is associated with higher mortality rate, higher mean airway pressure in invasive mechanically ventilated patients, and longer mechanical ventilation duration in the first 7 days of life. What is Known: • Fluid overload is associated with a higher mortality rate and prolonged mechanical ventilation in children and adults. What is New: • Fluid overload in the first 72 h of life in an extremely premature infant is associated with higher mortality rate, higher mean airway pressure in invasive mechanically ventilated patients, and longer mechanical ventilation duration the first 7 days of life.
Keywords Fluid overload . Preterm . Extremely low birth weight infants . Critical illness . Water-electrolyte imbalance Abbreviations CI Confidence interval CRIB II Clinical Risk Index for Babies G Grams MAP Mean airway pressure mL Milliliter
NICU OR SD Wk
Neonatal intensive care unit Odds ratio Standard deviation Weeks
Introduction Communicated by Daniele De Luca * Werther Brunow de Carvalho [email protected] Felipe Yu Matsushita [email protected] Vera Lúcia Jornada Krebs [email protected] Alexandre Archanjo Ferraro [email protected] 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
The first 72 h of life in extremely low birth weight newborns represents an important period of physiological adaptation, with significant hemodynamic changes [1]. In normal newborns, after umbilical cord clamping, placental disconnection, and the onset of respiration, the systemic vascular resistance gradually increases and there is a decline in pulmonary vascular resistance. Any disagreement with this adaptation may lead to hemodynamic instabil
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