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Evaluation of First-Week Fluid Intake and Maximal Weight Loss Percentage with In-Hospital Adverse Outcomes Among
Gregory C Valentine1, Tessa Rue1, Olivia C Brandon1
1Division of Neonatology, University of Washington, Seattle Children's Hospital, Seattle, WA 98195, USA.
Insights
Excessive first-week weight loss in premature infants is linked to poor health outcomes. Higher enteral fluid intake improves outcomes, while parenteral intake worsens them in low-resource settings.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Global Health
Background:
- Understanding fluid intake and weight loss in preterm infants is crucial for improving outcomes.
- Gaps exist in knowledge regarding first-week maximal weight loss (MWL) and fluid intake in low- and middle-income countries (LMICs).
Purpose of the Study:
- To investigate the relationship between first-week MWL, total fluid intake (TFI), enteral intake, and parenteral intake with adverse in-hospital outcomes in preterm newborns in an LMIC.
- To identify key nutritional strategies for improving outcomes in vulnerable neonates.
Main Methods:
- Retrospective analysis of 490 preterm newborns (<34 weeks gestation or <1500g) surviving at least 7 days.
- Utilized univariate and multivariate regression models to assess associations between MWL, fluid intake parameters, and adverse outcomes.
- Data collected from St. Paul's Hospital Millennium Medical College neonatal intensive care unit in Ethiopia.
Main Results:
- Greater than 13% MWL was associated with increased odds of suspected necrotizing enterocolitis (NEC), sepsis, retinopathy of prematurity (ROP), and longer length of stay (LOS).
- Average enteral intake >60 mL/kg/day correlated with reduced odds of mortality, NEC, sepsis, ROP, and shorter LOS.
- Average parenteral intake >60 mL/kg/day was linked to increased odds of mortality, sepsis, ROP, and longer LOS.
Conclusions:
- In LMIC settings, >13% MWL in preterm neonates signifies increased risk for adverse health outcomes.
- Optimizing enteral fluid intake in the first week is associated with improved outcomes for moderately and very preterm infants.
- Increased parenteral intake in the first week is associated with adverse outcomes, highlighting the importance of enteral feeding strategies.
Abstract:
Background/Objective: We sought to address ongoing gaps in understanding the relationship between first-week percent maximal weight loss (MWL) and average first-week total fluid intake (TFI), enteral intake, and parenteral intake among premature newborns with adverse in-hospital outcomes born in low- and middle-income countries (LMICs). Methods: We evaluated newborns born <34 weeks gestation or <1500 g who survived at least 7 days at the St. Paul's Hospital Millennium Medical College (SPHMMC) neonatal intensive care unit in Ethiopia. We performed univariate and multivariate regression models analyzing the first-week MWL, average TFI, parenteral, and enteral intake and their relationships with adverse in-hospital outcomes. Results: Among N = 490 moderately and very preterm newborns, multivariate regression models demonstrated that >13% MWL was associated with significantly increased odds of suspected necrotizing enterocolitis (NEC), culture-positive sepsis, retinopathy of prematurity (ROP), and a longer length of stay (LOS). An average enteral intake of >60 mL/kg/day was significantly associated with reduced odds of all-cause mortality, suspected NEC, culture-positive sepsis, ROP, and a shorter LOS, whereas an average parenteral intake of >60 mL/kg/day was associated with increased odds of in-hospital mortality, culture-positive sepsis, ROP, and a longer LOS. Conclusions: In moderately and very preterm neonates in an LMIC setting, >13% MWL is associated with adverse health outcomes. Increasing the average parenteral intake over the first week after birth among moderately and very preterm neonates is significantly associated with adverse in-hospital outcomes whereas increasing the average enteral intake is associated with improved outcomes.
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