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Abstract: SA-PO601

Fluid Balance and Return to Birth Weight Impact Short- and Long-Term Respiratory Outcomes in Premature Neonates

Session Information

  • Pediatric Nephrology - II
    November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1800 Pediatric Nephrology


  • Starr, Michelle C., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Gist, Katja M., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Segar, Jeff L., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
  • Raina, Rupesh, Cleveland Clinic Akron General, Akron, Ohio, United States
  • Guillet, Ronnie, Golisano Children's Hospital, Rochester, New York, United States
  • Nesargi, Saudamini, St. John's Medical College, India, India
  • Menon, Shina, Seattle Children's Hospital, Seattle, Washington, United States
  • Anderson, Nekayla, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
  • Askenazi, David J., The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
  • Selewski, David T., Medical University of South Carolina, Charleston, South Carolina, United States

Group or Team Name

  • Neonatal Kidney Collaborative

Premature neonates are at risk of acute kidney injury (AKI) and disordered fluid balance (FB). Few data exist on association between FB and respiratory outcomes in this population.


We evaluated neonates born 24–27 weeks in the PENUT study, a Phase III randomized, placebo-controlled trial in 30 US NICUs from 2013-16. Primary exposure: peak FB in the first 14 postnatal days. Secondary exposures: FB postnatal day 3 and return to birthweight day. FB was calculated as percent change from birthweight. Primary outcome: mechanical ventilation (MV) on postnatal day 14. Composite secondary outcome: severe bronchopulmonary dysplasia (BPD) or death.


923 preterm neonates were included. Weight was available for 13,394 of 13,845 (96.7%) potential patient-days. 480/923 (53.5%) were MV on postnatal day 14 and 554/923 (60.0%) had severe BPD/death.

Neonates with peak FB >5% had 1.75 higher odds (95% CI 1.33, 2.31,p<0.0001) of MV on postnatal day 14, and 1.51 higher odds (95% CI 1.11, 2.06,p=0.009) of severe BPD/death. After adjusting for confounding variables, for every 5% increase in peak fluid balance there was 2.21 higher odds of MV on postnatal day 14 (aOR 2.21, 95% CI: 1.61, 2.80;p<0.0001).(Table 1)

Median return to birthweight was shorter in neonates who were MV on postnatal day 14 (7d vs. 8d; p<0.0001) and those with severe BPD (7d vs. 8d, p=.0003) (Figure 1). Neonates who did not drop below their birth weight were more likely to be MV (68% vs. 59%, p=.0041).


Peak FB was associated with MV and severe BPD/death. Time to regain birth weight and 5% fluid overload are actionable markers of poor pulmonary outcomes. Future work should determine if interventions including targeted fluid management or individualized fluid delivery guided improve patient outcomes.


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