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  • Clinical Research Article
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Early feeding and fluid volume associations with adverse in-hospital outcomes among premature newborns

Pediatric Research (2025)Cite this article

Abstract

Background

High average total fluid intakes in the first week after birth are linked to adverse outcomes in preterm infants, including necrotizing enterocolitis (NEC) and bronchopulmonary dysplasia (BPD). Relative contributions of enteral and parenteral fluids remain unclear.

Objective

Evaluate associations between average enteral, parenteral, and total fluid intake in the first postnatal week and morbidity and mortality in preterm newborns.

Methods

In this retrospective study of 185 infants born ≤30 weeks or ≤1250 g who survived seven days in a level IV NICU, we assessed relationships between fluid intake and adverse outcomes, including mortality, length of stay (LOS), NEC, and BPD.

Results

Each 10 mL/kg/day increase in enteral intake averaged over the first postnatal week was associated with 30% lower odds of BPD, 35% lower odds of mortality (aOR 0.70, 95% CI 0.58–0.85; aOR 0.65, 95% CI 0.46–0.93), and shorter LOS (−4.77 days, 95% CI −7.26, −2.29). Higher average enteral feeds were not associated with adverse outcomes. Higher average parenteral and total fluid intakes were associated with increased odds of BPD, mortality, and prolonged LOS.

Conclusion

Higher average enteral intake in the first week is associated with improved outcomes in preterm infants.

Impact

  • Previous research on extremely low birthweight infants reported that high total fluid intake within the first week after birth is associated with increased risk of adverse outcomes

  • The relative contributions of parenteral fluid versus enteral feeding volumes have not been evaluated.

  • Among neonates born at ≤30 gestational weeks or ≤1250 g, higher enteral intake was associated with decreased odds of mortality, bronchopulmonary dysplasia, and a shorter length of stay.

  • Higher parenteral fluid intake and higher total fluid intake were associated with increased odds of adverse outcomes.

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Fig. 1: Unadjusted relationship between early fluid intake and in-hospital mortality proportion in the first postnatal week.
Fig. 2: Forest plots depicting adjusted associations between early fluid intake and in-hospital outcomes.
Fig. 3: Forest plots depicting adjusted associations between early fluid intake and composite in-hospital outcomes with mortality.

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Data availability

The data described in the manuscript and/or analyzed during the current study will be made available upon reasonable request to the corresponding author.

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Author information

Author notes

  1. These authors contributed equally: Olivia C. Brandon, Gregory C. Valentine.

Authors and Affiliations

  1. Division of Neonatology, University of Washington/Seattle Children’s Hospital, Seattle, WA, USA

    Olivia C. Brandon, Gregory C. Valentine, Sarah E. Kolnik, Sandra E. Juul, Thomas R. Wood & Krystle M. Perez

  2. Department of Obstetrics & Gynecology at Baylor College of Medicine, Houston, TX, USA

    Gregory C. Valentine

  3. Institute on Human Development and Disability, University of Washington, Seattle, WA, USA

    Sandra E. Juul & Thomas R. Wood

Authors
  1. Olivia C. Brandon
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  2. Gregory C. Valentine
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  3. Sarah E. Kolnik
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  4. Sandra E. Juul
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  5. Thomas R. Wood
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  6. Krystle M. Perez
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Contributions

GV and KP designed research; O.B., G.V., and S.K. conducted research; O.B. and T.W. analyzed data; O.B., G.V., and K.P. wrote the paper; O.B., G.V., S.K., S.J., T.W., and K.P. had responsibility for final content. All authors read and approved the final paper.

Corresponding author

Correspondence to Olivia C. Brandon.

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Competing interests

The authors declare no competing interests.

Consent

Patient consent was not required as this is a retrospective clinical study approved using a de-identified database and approved through the University of Washington Institutional Review Board (STUDY00006091). The study was performed in accordance with the Declaration of Helsinki (revised 2013).

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Brandon, O.C., Valentine, G.C., Kolnik, S.E. et al. Early feeding and fluid volume associations with adverse in-hospital outcomes among premature newborns. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04494-z

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