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Kidney Week

Abstract: FR-PO106

The Epidemiology and Impact of Fluid Balance on Outcomes in Critically Ill Near-Term/Term Neonates: A Report from the AWAKEN Study

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational


  • Selewski, David T., University of Michigan, Ann Arbor, Michigan, United States
  • Akcan Arikan, Ayse, Baylor College of Medicine, Houston, Texas, United States
  • Bonachea, Elizabeth, Nationwide Children''s hospital, Columbus, Ohio, United States
  • Gist, Katja M., University of Colorado, Children''s Hospital Colorado, Aurora, Colorado, United States
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Hanna, Mina, University of Kentucky, Lexington, Kentucky, United States
  • Joseph, Catherine, University of New Mexico, Albuquerque, New Mexico, United States
  • Mahan, John D., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Nada, Arwa, LeBonheur Children's Hospital, Memphis, Tennessee, United States
  • Nathan, Amy, Cincinnati Children''s Hospital Medical Center, Cincinnati, Ohio, United States
  • Reidy, Kimberly J., Children's Hospital at Montefiore/ Albert Einstein College of Medicine, Bronxville, New York, United States
  • Staples, Amy, University of New Mexico, Albuquerque, New Mexico, United States
  • Wintermark, Pia, McGill University, Montreal, Quebec, Canada
  • Boohaker, Louis J., Children''s of Alabama, Hoover, Alabama, United States
  • Griffin, Russell, University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Askenazi, David J., University of Alabama at Birmingham , Birmingham, Alabama, United States
  • Guillet, Ronnie, University of Rochester, Rochester, New York, United States

Group or Team Name

  • On behalf of Neonatal Kidney Collaborative

Neonates in the neonatal intensive care unit(NICU) are at increased risk of AKI and disorders of fluid balance(FB). Although normal term neonates are expected to lose weight (5-10%) over the first week of life, a paucity of data exists on FB in critically ill neonates. We aim to evaluate FB in the first week of life in a multi-center cohort of critically ill near-term/term neonates and the impact of FB on outcomes.


The Assessment of Worldwide Acute Kidney injury Epidemiology in Neonates (AWAKEN) study included NICU admissions at 24 institutions (4 countries) from 01/14-03/14. Inclusion criteria: intravenous fluids for ≥48 hrs. Exclusion criteria: congenital heart disease repair at <7 days of life(DOL), lethal anomaly or death at ≤48 hrs. This analysis includes infants ≥36 wks gestational age admitted by DOL 7. FB was defined by percentage change in weight from birthweight(BW). Outcomes: Mechanical ventilation(MV) at DOL 7, NICU mortality


749 neonates were included, median peak FB was 0.6%(-0.8, 4.3) and occurred at a median DOL 2(IQR 1,5). Peak FB over the first week was: <0%(<BW) in 231(30.5%), 0-5% in 345(45.4%), 5-10% in 90(11.9%), 10-15% in 39(5.1%), and >15% in 44(5.9%). 67(9%) were on MV on DOL 7 and 17(2.3%) died. Table 1 describes the association of variables, including FB, with MV at DOL 7. FB was not associated with mortality.


The AWAKEN study describes for the first time, the epidemiology and impact of FB in critically ill near-term/term neonates. Over half of the cohort had a positive peak FB in the first week of life. Peak FB during the first week of life was associated with the need for MV at DOL 7.

Table 1: Association of variables with Mechanical Ventilation at day of life 7