Association of fluid overload with patent ductus arteriosus during the first postnatal day

Evidence examining the association of over-hydration during early life with hemodynamically significant patent ductus arteriosus (hsPDA) and other morbidities is limited. Our aim was to evaluate the association of fluid overload during the first postnatal day with hsPDA and common neonatal morbidities such as bronchopulmonary dysplasia in preterm infants.

A retrospective cohort study was conducted enrolling infants ≤30 weeks' gestation and ≤1500 grams' birth weight, admitted to a tertiary Neonatal Unit. We calculated the fluid balance, and we estimated the incidence of infants with fluid overload ≥5% during the first postnatal day, evaluating any possible correlation with hsPDA.

One hundred three infants of 27.3±1.6 weeks' gestation and 1009±225 grams' birth weight were enrolled, of whom 32 (31%) were diagnosed with HsPDA. Fluid overload during the first postnatal day was recorded in 42 infants (41%). Infants with fluid overload were diagnosed with hsPDA in 48%, compared to 20% of infants without fluid overload (P=0.004). No differences were recorded in the development of bronchopulmonary dysplasia or survival. Fluid overload of ≥5% was significantly correlated with hsPDA (r=0.37, P=0.003) and had an independent contribution to the risk of hsPDA (OR=1.17, 95% CI: 1.05-1.58), irrespective of other perinatal factors.

In preterm infants, fluid overload ≥5% is significantly associated with hsPDA; therefore, fluid management during the first postnatal day should be closely regulated.