Abstract
Background
We evaluated the epidemiology of fluid balance (FB) over the first postnatal week and its impact on outcomes in a multi-center cohort of premature neonates from the AWAKEN study.
Methods
Retrospective analysis of infants <36 weeks’ gestational age from the AWAKEN study (N = 1007). FB was defined by percentage of change from birth weight. Outcome: Mechanical ventilation (MV) at postnatal day 7.
Results
One hundred and forty-nine (14.8%) were on MV at postnatal day 7. The median peak FB was 0% (IQR: −2.9, 2) and occurred on postnatal day 2 (IQR: 1,5). Multivariable models showed that the peak FB (aOR 1.14, 95% CI 1.10–1.19), lowest FB in first postnatal week (aOR 1.12, 95% CI 1.07–1.16), and FB on postnatal day 7 (aOR 1.10, 95% CI 1.06–1.13) were independently associated with MV on postnatal day 7. In a similar analysis, a negative FB at postnatal day 7 protected against the need for MV at postnatal day 7 (aOR 0.21, 95% CI 0.12–0.35).
Conclusions
Positive peak FB during the first postnatal week and more positive FB on postnatal day 7 were independently associated with MV at postnatal day 7. Those with a negative FB at postnatal day 7 were less likely to require MV.
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Acknowledgements
The authors would also like to thank the outstanding work of the following clinical research personnel and colleagues for their involvement in AWAKEN: Ariana Aimani, Samantha Kronish, Ana Palijan, MD, Michael Pizzi—Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada; Laila Ajour, BS, Julia Wrona, BS—University of Colorado, Children's Hospital Colorado, Aurora, CO; Melissa Bowman, RN—University of Rochester, Rochester, NY; Teresa Cano, RN, Marta G. Galarza, MD, Wendy Glaberson, MD, Aura Arenas Morales, MD, Denisse, Cristina Pareja Valarezo, MD—Holtz Children's Hospital, University of Miami, Miami, FL; Sarah Cashman, BS, Madeleine Stead, BS—University of Iowa Children’s Hospital, Iowa City, IA; Jonathan Davis, MD, Julie Nicoletta, MD—Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, Boston, MA; Alanna DeMello—British Columbia Children's Hospital, Vancouver, BC, Canada; Lynn Dill, RN—University of Alabama at Birmingham, Birmingham, AL; Ellen Guthrie, RN—MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH; Nicholas L. Harris, BS, Susan M. Hieber, MSQM—C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; Katherine Huang, Rosa Waters—University of Virginia Children’s Hospital, Charlottesville, VA; Judd Jacobs, Ryan Knox, BS, Hilary Pitner, MS, Tara Terrell—Cincinnati Children’s Hospital Medical, Center, Cincinnati, OH; Nilima Jawale, MD—Maimonides Medical Center, Brooklyn, NY; Emily Kane—Australian National University, Canberra, ACT, Australia; Vijay Kher, DM, Puneet Sodhi, MBBS—Medanta Kidney Institute, The Medicity Hospital, Gurgaon, Haryana, India; Grace Mele—New York College of Osteopathic Medicine, Westbury, NY; Patricia Mele, DNP—Stony Brook Children’s Hospital, Stony Brook, NY; Charity Njoku, Tennille Paulsen, Sadia Zubair—Texas Children’s Hospital, Baylor College of Medicine, Houston, TX; Emily Pao—University of Washington, Seattle Children's Hospital, Seattle, WA; Becky Selman RN, Michele Spear, CCRC—University of New Mexico Health Sciences Center, Albuquerque, NM; Melissa Vega, PA-C—The Children’s Hospital at Montefiore, Bronx, NY, USA); Leslie Walther, RN—Washington University, St. Louis, MO. Cincinnati Children’s Hospital Center for Acute Care Nephrology provided funding to create and maintain the AWAKEN Medidata Rave electronic database. The Pediatric and Infant Center for Acute Nephrology (PICAN) provided support for web meetings, for the NKC steering committee annual meeting at the University of Alabama at Birmingham (UAB), as well as support for some of the AWAKEN investigators at UAB (L.J.B., R. Griffin). PICAN is part of the Department of Pediatrics at the University of Alabama at Birmingham (UAB) and is funded by Children’s of Alabama Hospital, the Department of Pediatrics, UAB School of Medicine, and UAB’s Center for Clinical and Translational Sciences (CCTS, NIH grant UL1TR001417). Finally, the AWAKEN study at the University of New Mexico was supported by the Clinical and Translational Science Center (CTSC, NIH grant UL1TR001449) and by the University of Iowa Institute for Clinical and Translational Science (U54TR001356). C.L.A. was supported by the Micah Batchelor Foundation. A.-A.A. and C.J.R. were supported by the Section of Pediatric Nephrology, Department of Pediatrics, Texas Children’s Hospital. J.R.C. and J.R.S. were supported by a grant from 100 Women Who Care. F.S.C. and K.T.D. were supported by the Edward Mallinckrodt Department of Pediatrics at Washington University School of Medicine. J.F. and A.K. supported by the Canberra Hospital Private Practice Fund. R.G. and E.R. were supported by the Department of Pediatrics, Golisano Children’s Hospital, University of Rochester. P.E.R. was supported by R01 HL-102497, R01 DK 49419. S.S. and D.T.S. were supported by the Department of Pediatrics & Communicable Disease, C.S. Mott Children’s Hospital, University of Michigan. S.S. and R.W. were supported by Stony Brook Children’s Hospital Department of Pediatrics funding. Funding sources for this study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Neonatal Kidney Collaborative
Namasivayam Ambalavanan17, Subrata Sarkar18, Alison Kent19, Jeffery Fletcher19, Carolyn L. Abitbol20, Marissa DeFreitas20, Shahnaz Duara20, Jennifer R. Charlton21, Jonathan R. Swanson21, Carl D’Angio22, Ayesa Mian22, Erin Rademacher22, Maroun J. Mhanna23, Rupesh Raina23, Deepak Kumar23, Jennifer G. Jetton24, Patrick D. Brophy24, Tarah T. Colaizy24, Jonathan M. Klein24, Christopher J. Rhee25, Juan C. Kupferman26, Alok Bhutada26, Shantanu Rastogi26, Susan Ingraham27, F. Sessions Cole28, T. Keefe Davis28, Lawrence Milner29, Alexandra Smith29, Mamta Fuloria30, Frederick J. Kaskel30, Danielle E. Soranno31, Jason Gien31, Aftab S. Chishti32, Sangeeta Hingorani33, Michelle Starr33, Sunny Juul33, Craig S. Wong34, Tara DuPont34, Robin Ohls34, Surender Khokhar35, Sofia Perazzo36, Patricio E. Ray36, Mary Revenis36, Sidharth K. Sethi37, Smriri Rohatgi37, Cherry Mammen38, Anne Synnes38, Sanjay Wazir39, Michael Zappitelli40, Robert Woroniecki41, Shanty Sridhar41
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All listed authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, and final approval of the version to be published.
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D.J.A. serves on the speaker board for Baxter (Baxter, USA) and the Acute Kidney Injury (AKI) Foundation (Cincinnati, OH, USA); he also receives grant funding for studies not related to this manuscript from National Institutes of Health—National Institutes of Diabetes and Digestive and Kidney Diseases (NIH-NIDDK (R01 DK103608) and NIH-FDA (R01 FD005092)). K.M.G. is a consultant for BioPorto. The other authors declare no competing interests.
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Selewski, D.T., Gist, K.M., Nathan, A.T. et al. The impact of fluid balance on outcomes in premature neonates: a report from the AWAKEN study group. Pediatr Res 87, 550–557 (2020). https://doi.org/10.1038/s41390-019-0579-1
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DOI: https://doi.org/10.1038/s41390-019-0579-1
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