Individualized fluid management in extremely preterm neonates to ensure adequate diuresis without increasing...

Area of Science:

• Neonatalogy
• Pediatric Nephrology
• Quality Improvement Science

Background:

• Extremely preterm neonates (<28 weeks gestation) are at high risk for inadequate diuresis (ID), defined as <6% birth weight loss in the first week.
• Inadequate diuresis in this population can lead to significant complications.
• Optimizing fluid management is crucial for improving outcomes in extremely preterm infants.

Purpose of the Study:

• To decrease the incidence of inadequate diuresis (ID) in extremely preterm neonates (EPT) by 50% within one year.
• To evaluate the impact of a standardized fluid management protocol on ID and associated morbidities.

Main Methods:

• A quality improvement project was conducted in a level IV NICU.
• A fluid management protocol, including a fluid guide sheet and enhanced monitoring, was implemented.
• Seventy-nine baseline EPT neonates were compared to 83 post-intervention EPT neonates.

Main Results:

• Fluid volumes administered in the first week of life were significantly decreased (p < 0.001).
• The incidence of inadequate diuresis decreased from 43% to 29% (p = 0.061).
• No statistically significant differences were observed in tracked morbidities and complications between the pre- and post-intervention groups.

Conclusions:

• Intentional and individualized fluid adjustments effectively reduced inadequate diuresis in EPT neonates.
• The implemented protocol achieved a reduction in ID without increasing hypernatremia, dehydration, or other monitored complications.