Standard versus restricted fluid administration in preterm infants undergoing pharmacological treatment for...

Fluid management in patent ductus arteriosus (PDA) treatment is debated, with fluid restriction traditionally used to promote closure, though its impact on outcomes is uncertain.

This retro-prospective cohort single-center study compared two cohorts of preterm neonates receiving pharmacological treatment for hemodynamically significant PDA (hsPDA). The 2021-2023 cohort followed an updated, higher fluid intake protocol based on neonatal weight and day of life (80-100 ml/kg/day for extreme preterm <1000 g on day 1), while the 2018-2020 cohort adhered to a more restrictive approach based on gestational age and day of life (70 ml/kg/day for extreme preterm ≤26 weeks on day 1) and fluid restriction from 5 to 20% during pharmacological treatment of hsPDA. Outcomes included PDA closure rates, growth parameters, and neonatal complications.

hsPDA closure rates and major complications (intraventricular hemorrhage, necrotizing enterocolitis, or chronic lung disease) were similar between groups. However, fluid-restricted neonates required more central catheter days, longer times to full enteral feeding, and had poorer growth at discharge (lower weight z-scores).

Fluid restriction during pharmacological PDA treatment may adversely affect growth and clinical care without improving closure rates. A balanced, individualized fluid management strategy could enhance neonatal outcomes.

The article suggests that fluid restriction does not improve the response to pharmacological treatment for PDA, but could negatively influence growth of preterm infants before discharge, which might have long term repercussions. It highlights there is no benefit, but potential harm, of fluid restriction to promote PDA in this vulnerable population. The findings could guide changes in clinical practice, improving PDA management and potentially reducing complications for preterm infants who are highly sensitive to fluid imbalances. The study advocates for further clinical trials to explore the optimal hydration strategies in managing PDA, paving the way for future research that can refine and standardize treatment protocols.