Severe Bronchopulmonary Dysplasia is Associated with Higher Fluid Intake in Very Low-Birth-Weight Infants: A Retrospective Study
24 September 2013
14 April 2014
10 June 2014 (online)
Objective This study aims to investigate the association between fluid intake in the first 4 days of life and the subsequent severity of bronchopulmonary dysplasia (BPD) in very low-birth-weight infants (VLBWI).
Study Design A retrospective chart review of 75 infants with a gestational age of less than 32 weeks and a birth weight of < 1,500 g was performed. Demographic, clinical data, associated maternal risk factors, and amount of fluid received in the first 4 days of life were analyzed.
Results Severe BPD was associated with a lower gestational age (27.04 ± 2.073 wks vs. 28.70 ± 1.706 wks, p=0.001), lower birth weight (981.44 ± 244.54 vs. 1,199.63 ± 165.39 g, p < 0.001), use of surfactant (91.7 vs. 63%, p=0.002), patent ductus arteriousus (PDA) (70.8 vs. 37%, p=0.004), pulmonary hemorrhage (14.6 vs. 0%, p=0.045), and more fluids received from the 2nd to 4th days of life (346.44 ± 42.38 mL/kg vs. 323.91 ± 27.62 mL/kg, p=0.007). A cut off point of 345 mL/kg of fluids from the 2nd to 4th days of life was selected using receiver operating characteristic curve analysis, and remained a significant risk factor even after multiple logistic regression analysis.
Conclusion Our findings demonstrate that VLBWI who received higher fluid intake from the 2nd to 4th days of life are at an increased risk of developing severe BPD.
- 1 Langston C, Kida K, Reed M, Thurlbeck WM. Human lung growth in late gestation and in the neonate. Am Rev Respir Dis 1984; 129 (4) 607-613
- 2 Baraldi E, Filippone M. Chronic lung disease after premature birth. N Engl J Med 2007; 357 (19) 1946-1955
- 3 Oh W. Fluid and electrolyte management of very low birth weight infants. Pediatr Neonatol 2012; 53 (6) 329-333
- 4 Arant Jr BS. Developmental patterns of renal functional maturation compared in the human neonate. J Pediatr 1978; 92 (5) 705-712
- 5 Ross B, Cowett RM, Oh W. Renal functions of low birth weight infants during the first two months of life. Pediatr Res 1977; 11 (11) 1162-1164
- 6 Stonestreet BS, Bell EF, Warburton D, Oh W. Renal response in low-birth-weight neonates. Results of prolonged intake of two different amounts of fluid and sodium. Am J Dis Child 1983; 137 (3) 215-219
- 7 Bell EF, Acarregui MJ. Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2008; (1) CD000503
- 8 Bell EF, Warburton D, Stonestreet BS, Oh W. Effect of fluid administration on the development of symptomatic patent ductus arteriosus and congestive heart failure in premature infants. N Engl J Med 1980; 302 (11) 598-604
- 9 Lorenz JM, Kleinman LI, Kotagal UR, Reller MD. Water balance in very low-birth-weight infants: relationship to water and sodium intake and effect on outcome. J Pediatr 1982; 101 (3) 423-432
- 10 Smith VC, Zupancic JA, McCormick MC , et al. Trends in severe bronchopulmonary dysplasia rates between 1994 and 2002. J Pediatr 2005; 146 (4) 469-473
- 11 Shah PS, Sankaran K, Aziz K , et al; Canadian Neonatal Network. Outcomes of preterm infants <29 weeks gestation over 10-year period in Canada: a cause for concern?. J Perinatol 2012; 32 (2) 132-138
- 12 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (7) 1723-1729
- 13 Ehrenkranz RA, Walsh MC, Vohr BR , et al; National Institutes of Child Health and Human Development Neonatal Research Network. Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics 2005; 116 (6) 1353-1360
- 14 Oh W, Poindexter BB, Perritt R , et al; Neonatal Research Network. Association between fluid intake and weight loss during the first ten days of life and risk of bronchopulmonary dysplasia in extremely low birth weight infants. J Pediatr 2005; 147 (6) 786-790
- 15 Van Marter LJ, Leviton A, Allred EN, Pagano M, Kuban KC. Hydration during the first days of life and the risk of bronchopulmonary dysplasia in low birth weight infants. J Pediatr 1990; 116 (6) 942-949
- 16 Lorenz JM. Fluid and electrolyte therapy and chronic lung disease. Curr Opin Pediatr 2004; 16 (2) 152-156
- 17 Lewis AB, Heymann MA, Rudolph AM. Gestational changes in pulmonary vascular responses in fetal lambs in utero. Circ Res 1976; 39 (4) 536-541
- 18 Pérez Fontán JJ, Clyman RI, Mauray F, Heymann MA, Roman C. Respiratory effects of a patent ductus arteriosus in premature newborn lambs. J Appl Physiol (1985) 1987; 63 (6) 2315-2324
- 19 Clyman RI. The role of patent ductus arteriosus and its treatments in the development of bronchopulmonary dysplasia. Semin Perinatol 2013; 37 (2) 102-107
- 20 Bahadue FL, Soll R. Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev 2012; 11: CD001456
- 21 Ikegami M, Jacobs H, Jobe A. Surfactant function in respiratory distress syndrome. J Pediatr 1983; 102 (3) 443-447
- 22 Yen TA, Yang HI, Hsieh WS , et al; Taiwan Premature Infant Developmental Collaborative Study Group. Preeclampsia and the risk of bronchopulmonary dysplasia in VLBW infants: a population based study. PLoS ONE 2013; 8 (9) e75168