The Impact of Restricted versus Liberal Early Fluid Volumes on Plasma Sodium, Weight Change, and Short-Term Outcomes in Extremely Preterm Infants.

Barbro Diderholm,Erik Normann,Richard Sindelar,Johan Ågren,Fredrik Ahlsson

doi:10.3390/nu14040795

Abstract

The optimal fluid requirements for extremely preterm infants are not fully known. We examined retrospectively the fluid intakes during the first week of life in two cohorts of extremely preterm infants born at 22–26 weeks of gestation before (n = 63) and after a change from a restrictive to a more liberal (n = 112) fluid volume allowance to improve nutrient provision. The cohorts were similar in gestational age and birth weight, but antenatal steroid exposure was more frequent in the second era. Although fluid management resulted in a cumulative difference in the total fluid intake over the first week of 87 mL/kg (p < 0.001), this was not reflected in a mean weight loss (14 ± 5% at a postnatal age of 4 days in both groups) or mean peak plasma sodium (142 ± 5 and 143 ± 5 mmol/L in the restrictive and liberal groups, respectively). The incidences of hypernatremia (>145 and >150 mmol/L), PDA ligation, bronchopulmonary dysplasia, and IVH were also similar. We conclude that in this cohort of extremely preterm infants a more liberal vs. a restricted fluid allowance during the first week had no clinically important influence on early changes in body weight, sodium homeostasis, or hospital morbidities.

Highlights

The evidence base to guide initial fluid management for extremely preterm infants is limited
The regimes applied in these investigations were different, but in those where sodium intake was varied separately from water a restricted sodium intake resulted in a lower rate of bronchopulmonary dysplasia (BPD) and a lower mortality
These studies include a limited number of infants with a gestational age (GA) below 28 weeks and might not provide much guidance to the care provided to this subpopulation

Summary

Introduction

The evidence base to guide initial fluid management for extremely preterm infants is limited. The regimes applied in these investigations were different, but in those where sodium intake was varied separately from water a restricted sodium intake resulted in a lower rate of bronchopulmonary dysplasia (BPD) and a lower mortality. Based on these studies the most current recommendations [6] suggest an initial restriction of both water and sodium intake, presumably since in most instances an increased total fluid volume will infer an increased amount of sodium provided. Ume allowance to extremely preterm infants at a tertiary care neonatal intensive care unit

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Data Collection and Treatment

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