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Fluid Balance in Infants born at 22-23 Weeks' Gestation: Trajectories and Associations with Outcomes.

Nima Naseh,E. Bell,R. Sindelar,L. H. Westas,J. Ågren

Published 2025 in Jornal de Pediatria

ABSTRACT

OBJECTIVES To investigate fluid balance, sodium intake, and hyperglycemia during the first 2 weeks of life in infants born at 22-23 weeks' gestational age and examine their associations with hospital outcomes. STUDY DESIGN Retrospective, single-center, cohort study of all infants surviving beyond 72 hours (22-23 weeks; January 2019-June 2024). Total fluid intake (TFI), weight, and urine output (UOP) were collected during the first 14 days, and used to calculate daily insensible water loss (IWL). Daily intake of sodium, plasma sodium (P-Na) and glucose levels, and the occurrence of acute kidney injury (AKI) were recorded. Relationships with bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, and death were analyzed. RESULTS Survival until discharge was 57% (39/69). The nadir weight loss was -15±6% (mean ± SD) at median 3 (IQR 2-5) days. Average TFI during the first week of life was 176±25 mL/kg/day; peak mean UOP (119±39 mL/kg/day) and IWL (87±54 mL/kg/day) occurred on days 2 and 5, respectively. Median daily sodium intake was 4.6 and 4.5 mmol/kg/d in the first and second weeks, respectively. Hypernatremia (P-Na > 150 mmol/L) occurred in 42% and prolonged (>2 days) hyperglycemia (P-glucose >10 mmol/L) was frequent (87%). AKI occurred in 28%. Mortality was independently associated with weight loss >15% (OR 3.9, 95% CI 1.4-11.1, P=0.013), and AKI (OR 3.5, 95% CI 1.1-11.3, p=0.034). CONCLUSIONS In infants born at 22-23 weeks of gestation, a large loss of body weight and AKI are prevalent during the first two weeks of life, and are associated with increased mortality. Preventing excessive weight loss might improve outcomes.

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