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The Impact of Restricted versus Liberal Early Fluid Volumes on Plasma Sodium, Weight Change, and Short-Term Outcomes

Barbro Diderholm1, Erik Normann1, Fredrik Ahlsson1

  • 1Department of Women's and Children's Health, Uppsala University Children's Hospital, SE-75185 Uppsala, Sweden.

Nutrients
|February 26, 2022
PubMed

Insights

Fluid intake for extremely preterm infants doesn't significantly impact early outcomes. A more liberal fluid allowance showed no clinical difference in weight, sodium levels, or common morbidities compared to restricted fluids.

Area of Science:

  • Neonatalogy
  • Pediatric critical care
  • Perinatal medicine

Background:

  • Optimal fluid management for extremely preterm infants (born at 22-26 weeks gestation) remains unclear.
  • Previous practices involved restrictive fluid volume allowances, potentially limiting nutrient delivery.

Purpose of the Study:

  • To compare the effects of restrictive versus liberal fluid volume allowances in the first week of life on extremely preterm infants.
  • To assess the influence of fluid management strategies on early physiological parameters and morbidities.

Main Methods:

  • Retrospective analysis of fluid intake in two cohorts of extremely preterm infants before and after a policy change.
  • Comparison of cumulative fluid intake, body weight changes, peak plasma sodium levels, and incidence of major morbidities.

Main Results:

  • A liberal fluid allowance increased total fluid intake by 87 mL/kg over the first week (p < 0.001) but did not alter mean weight loss or peak plasma sodium levels.
  • No significant differences were observed in the incidence of hypernatremia, patent ductus arteriosus ligation, bronchopulmonary dysplasia, or intraventricular hemorrhage between groups.

Conclusions:

  • In extremely preterm infants, a liberal fluid allowance compared to a restricted one during the first week of life did not lead to clinically significant differences in early weight changes, sodium homeostasis, or hospital morbidities.
  • These findings suggest flexibility in fluid management strategies for this vulnerable population.

Keywords:
dehydrationextremely preterm infantfluid allowance

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