Abstract: PO1953
The Association of Diuretic Therapy with Fluid Balance and AKI in Hospitalized Preterm Neonates
Session Information
- Pediatric Nephrology: AKI, Dialysis, Transplant, CKD, and Nephrotic Syndrome
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1700 Pediatric Nephrology
Authors
- Wright, Mariah L., Nationwide Children's Hospital, Columbus, Ohio, United States
- Klamer, Brett, Nationwide Children's Hospital, Columbus, Ohio, United States
- Bonachea, Elizabeth, Nationwide Children's Hospital, Columbus, Ohio, United States
- Spencer, John David, Nationwide Children's Hospital, Columbus, Ohio, United States
- Slaughter, Jonathan L., Nationwide Children's Hospital, Columbus, Ohio, United States
- Mohamed, Tahagod, Nationwide Children's Hospital, Columbus, Ohio, United States
Background
Fluid homeostasis is essential in critically ill preterm neonates because fluid overload is associated with poor outcomes including need for mechanical ventilation, bronchopulmonary dysplasia (BPD) and necrotizing enterocolitis (NEC). Acute kidney injury (AKI) is a common comorbidity in preterm neonates. Diuretics are often used to enhance urinary output (UOP) in AKI- associated oliguria and to achieve negative fluid balance (FB).
Methods
Retrospective study of preterm neonates < 37 weeks gestational age (GA) who received diuretics during the first 14 postnatal days in a single level IV NICU (05/2014- 05/2020). We analyzed FB, UOP, and Scr levels on and off diuretics over first 14 days. We studied prevalence of AKI.
Results
191 preterm neonates met inclusion criteria. By day 8, 50% of patients were treated with diuretics. After adjusting for birthweight and time after birth, there was a statistically significant decrease in weights while on diuretics with a mean difference of 10g. Peak median FB was +58 mL on postnatal day 8. Mean FB difference on and off diuretic therapy was -35 mL. There was smaller difference in FB between those on or off diuretics in younger GA patients compared to older GA patients (Figure 1). UOP increased by 0.6 mL/kg/h and Scr by 0.2mg/dL while on diuretics compared to no diuretic therapy (Table 1). AKI occurred in 9% and 19% of patients based on an increase in Scr of ≥ 0.3 mg/dL or UOP < 1ml/kg/h for 24 hours respectively. In patients who met AKI criteria, oliguria was noted while off diuretics and increased Scr while on diuretics.
Conclusion
In hospitalized preterm neonates, treatment with diuretics was associated with improved UOP and negative fluid balance. SCr increased while on diuretic therapy. Further studies should analyze the effects of diuretics as mediated by FB and AKI on development of BPD and NEC.
Distribution of weight, FB, UOP and Scr in preterm neonates on and off diuretic therapy
| On diuretics | Off diuretics | Difference on and off diuretics | |
| Weight (g) | 1523 | 1537 | -10 |
| Mean FB (mL) | 31 | 66 | -35 |
| Mean UOP (mL/kg/h) | 3.2 | 3.9 | 0.6 |
| Mean Scr (mg/dL) | 1.1 | 0.9 | 0.2 |