The impact of fluid balance on outcomes in critically ill near-term/term neonates: a report from the AWAKEN study group

on behalf of the Neonatal Kidney Collaborative

doi:10.1038/s41390-018-0183-9

The impact of fluid balance on outcomes in critically ill near-term/term neonates: a report from the AWAKEN study group

on behalf of the Neonatal Kidney Collaborative

Pediatrics

Research output: Contribution to journal › Article › peer-review

41 Scopus citations

Abstract

Background: In sick neonates admitted to the NICU, improper fluid balance can lead to fluid overload. We report the impact of fluid balance in the first postnatal week on outcomes in critically ill near-term/term neonates. Methods: This analysis includes infants ≥36 weeks gestational age from the Assessment of Worldwide Acute Kidney injury Epidemiology in Neonates (AWAKEN) study (N = 645). Fluid balance: percent weight change from birthweight. Primary outcome: mechanical ventilation (MV) on postnatal day 7. Results: The median peak fluid balance was 1.0% (IQR: −0.5, 4.6) and occurred on postnatal day 3 (IQR: 1, 5). Nine percent required MV at postnatal day 7. Multivariable models showed the peak fluid balance (aOR 1.12, 95%CI 1.08–1.17), lowest fluid balance in 1st postnatal week (aOR 1.14, 95%CI 1.07–1.22), fluid balance on postnatal day 7 (aOR 1.12, 95%CI 1.07–1.17), and negative fluid balance at postnatal day 7 (aOR 0.3, 95%CI 0.16–0.67) were independently associated with MV on postnatal day 7. Conclusions: We describe the impact of fluid balance in critically ill near-term/term neonates over the first postnatal week. Higher peak fluid balance during the first postnatal week and higher fluid balance on postnatal day 7 were independently associated with MV at postnatal day 7.

Original language	English (US)
Pages (from-to)	79-85
Number of pages	7
Journal	Pediatric Research
Volume	85
Issue number	1
DOIs	https://doi.org/10.1038/s41390-018-0183-9
State	Published - Jan 1 2019

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health

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10.1038/s41390-018-0183-9

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@article{37d4fc47f4de40ae9e3160ee12165f79,

title = "The impact of fluid balance on outcomes in critically ill near-term/term neonates: a report from the AWAKEN study group",

abstract = "Background: In sick neonates admitted to the NICU, improper fluid balance can lead to fluid overload. We report the impact of fluid balance in the first postnatal week on outcomes in critically ill near-term/term neonates. Methods: This analysis includes infants ≥36 weeks gestational age from the Assessment of Worldwide Acute Kidney injury Epidemiology in Neonates (AWAKEN) study (N = 645). Fluid balance: percent weight change from birthweight. Primary outcome: mechanical ventilation (MV) on postnatal day 7. Results: The median peak fluid balance was 1.0% (IQR: −0.5, 4.6) and occurred on postnatal day 3 (IQR: 1, 5). Nine percent required MV at postnatal day 7. Multivariable models showed the peak fluid balance (aOR 1.12, 95%CI 1.08–1.17), lowest fluid balance in 1st postnatal week (aOR 1.14, 95%CI 1.07–1.22), fluid balance on postnatal day 7 (aOR 1.12, 95%CI 1.07–1.17), and negative fluid balance at postnatal day 7 (aOR 0.3, 95%CI 0.16–0.67) were independently associated with MV on postnatal day 7. Conclusions: We describe the impact of fluid balance in critically ill near-term/term neonates over the first postnatal week. Higher peak fluid balance during the first postnatal week and higher fluid balance on postnatal day 7 were independently associated with MV at postnatal day 7.",

author = "{on behalf of the Neonatal Kidney Collaborative} and Selewski, {David T.} and Ayse Akcan-Arikan and Bonachea, {Elizabeth M.} and Gist, {Katja M.} and Goldstein, {Stuart L.} and Mina Hanna and Catherine Joseph and Mahan, {John D.} and Arwa Nada and Nathan, {Amy T.} and Kimberly Reidy and Amy Staples and Pia Wintermark and Boohaker, {Louis J.} and Russell Griffin and Askenazi, {David J.} and Ronnie Guillet and Sunny Juul and Namasivayam Ambalavanan and Subrata Sarkar and Alison Kent and Jeffery Fletcher and Abitbol, {Carolyn L.} and Marissa DeFreitas and Shahnaz Duara and Charlton, {Jennifer R.} and Swanson, {Jonathan R.} and Carl D{\textquoteright}Angio and Ayesa Mian and Erin Rademacher and Mhanna, {Maroun J.} and Rupesh Raina and Deepak Kumar and Jetton, {Jennifer G.} and Brophy, {Patrick D.} and Colaizy, {Tarah T.} and Klein, {Jonathan M.} and Rhee, {Christopher J.} and Kupferman, {Juan C.} and Alok Bhutada and Shantanu Rastogi and Susan Ingraham and Cole, {F. Sessions} and Davis, {T. Keefe} and Lawrence Milner and Alexandra Smith and Mamta Fuloria and Kaskel, {Frederick J.} and Soranno, {Danielle E.} and Jason Gien",

note = "Funding Information: The authors would also like to thank the outstanding work of the following clinical research personnel and colleagues for their involvement in AWAKEN: Ariana Aimani, Samantha Kronish, Ana Palijan, MD, and Michael Pizzi—Montreal Children{\textquoteright}s Hospital, McGill University Health Centre, Montreal, Quebec, Canada. Laila Ajour, BS, Julia Wrona, BS—University of Colorado, Children{\textquoteright}s Hospital Colorado, Aurora, Colorado. Melissa Bowman, RN—University of Rochester, Rochester, New York. Teresa Cano, RN, Marta G. Galarza, MD, Wendy Glaberson, MD, Aura Arenas Morales, MD, Denisse Cristina Pareja Valarezo, MD—Holtz Children{\textquoteright}s Hospital, University of Miami, Miami, Florida. Sarah Cashman, BS, Madeleine Stead, BS—University of Iowa Children{\textquoteright}s Hospital, Iowa City, Iowa. Jonathan Davis, MD, Julie Nicoletta, MD—Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts. Alanna DeMello—British Columbia Children{\textquoteright}s Hospital, Vancouver, British Columbia, Canada. Lynn Dill, RN—University of Alabama at Birmingham, Birmingham, Alabama. Ellen Guthrie, RN—MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio. Nicholas L. Harris, BS, Susan M. Hieber, MSQM— C.S. Mott Children{\textquoteright}s Hospital, University of Michigan, Ann Arbor, Michigan. Katherine Huang, Rosa Waters—University of Virginia Children{\textquoteright}s Hospital, Charlottesville, Virginia. Judd Jacobs, Ryan Knox, BS, Hilary Pitner, MS, Tara Terrell— Cincinnati Children{\textquoteright}s Hospital Medical Center, Cincinnati, Ohio. Nilima Jawale, MD—Maimonides Medical Center, Brooklyn, New York. Emily Kane—Australian National University, Canberra, Australia. Vijay Kher, DM, Puneet Sodhi, MBBS—Medanta Kidney Institute, The Medicity Hospital, Gurgaon, Haryana, India. Grace Mele—New York College of Osteopathic Medicine, Westbury, New York. Patricia Mele, DNP—Stony Brook Children{\textquoteright}s Hospital, Stony Brook, New York. Charity Njoku, Tennille Paulsen, Sadia Zubair—Texas Children{\textquoteright}s Hospital, Baylor College of Medicine, Houston, Texas. Emily Pao—University of Washington, Seattle Children{\textquoteright}s Hospital, Seattle, Washington. Becky Selman, RN, Michele Spear, CCRC—University of New Mexico Health Sciences Center Albuquerque, New Mexico. Melissa Vega, PA-C—The Children{\textquoteright}s Hospital at Montefiore, Bronx, New York, USA. Leslie Walther, RN—Washington University, St. Louis, Missouri. Funding sources: Cincinnati Children{\textquoteright}s Hospital Center for Acute Care Nephrology provided funding to create and maintain the AWAKEN Medidata Rave electronic database. The Pediatric and Infant Center for Acute Nephrology (PICAN) provided support for web meetings, for the NKC steering committee annual meeting at the University of Alabama at Birmingham (UAB), as well as support for some of the AWAKEN investigators at UAB (LJB., R.G.). PICAN is part of the Department of Pediatrics at the University of Alabama at Birmingham (UAB), and is funded by Children{\textquoteright}s of Alabama Hospital, the Department of Pediatrics, UAB School of Medicine, and UAB{\textquoteright}s Center for Clinical and Translational Sciences (CCTS, NIH grant UL1TR001417). Finally, the AWAKEN study at the University of New Mexico was supported by the Clinical and Translational Science Center (CTSC, NIH grant UL1TR001449) and by the University of Iowa Institute for Clinical and Translational Science (U54TR001356). C.L.A. was supported by the Micah Batchelor Foundation. A. A.A. and C.J.R. were supported by the Section of Pediatric Nephrology, Department of Pediatrics, Texas Children{\textquoteright}s Hospital. J.R.C. and J.R.S. were supported by a grant from 100 Women Who Care. F.S.C. and K.T.D. were supported by the Edward Mallinckrodt Department of Pediatrics at Washington University School of Medicine. J.F. and A.K. supported by the Canberra Hospital Private Practice Fund. R.G. and E.R. were supported by the Department of Pediatrics, Golisano Children{\textquoteright}s Hospital, University of Rochester. P.E.R. was supported by R01 HL-102497, R01 DK 49419. S.S. and D.T.S. were supported by the Department of Pediatrics & Communicable Disease, C.S. Mott Children{\textquoteright}s Hospital, University of Michigan. S.S. and R.W. were supported by Stony Brook Children{\textquoteright}s Hospital Department of Pediatrics funding. Publisher Copyright: {\textcopyright} 2018, International Pediatric Research Foundation, Inc.",

year = "2019",

month = jan,

day = "1",

doi = "10.1038/s41390-018-0183-9",

language = "English (US)",

volume = "85",

pages = "79--85",

journal = "Pediatric Research",

issn = "0031-3998",

publisher = "Lippincott Williams and Wilkins",

number = "1",

}

TY - JOUR

T1 - The impact of fluid balance on outcomes in critically ill near-term/term neonates

T2 - a report from the AWAKEN study group

AU - on behalf of the Neonatal Kidney Collaborative

AU - Selewski, David T.

AU - Akcan-Arikan, Ayse

AU - Bonachea, Elizabeth M.

AU - Gist, Katja M.

AU - Goldstein, Stuart L.

AU - Hanna, Mina

AU - Joseph, Catherine

AU - Mahan, John D.

AU - Nada, Arwa

AU - Nathan, Amy T.

AU - Reidy, Kimberly

AU - Staples, Amy

AU - Wintermark, Pia

AU - Boohaker, Louis J.

AU - Griffin, Russell

AU - Askenazi, David J.

AU - Guillet, Ronnie

AU - Juul, Sunny

AU - Ambalavanan, Namasivayam

AU - Sarkar, Subrata

AU - Kent, Alison

AU - Fletcher, Jeffery

AU - Abitbol, Carolyn L.

AU - DeFreitas, Marissa

AU - Duara, Shahnaz

AU - Charlton, Jennifer R.

AU - Swanson, Jonathan R.

AU - D’Angio, Carl

AU - Mian, Ayesa

AU - Rademacher, Erin

AU - Mhanna, Maroun J.

AU - Raina, Rupesh

AU - Kumar, Deepak

AU - Jetton, Jennifer G.

AU - Brophy, Patrick D.

AU - Colaizy, Tarah T.

AU - Klein, Jonathan M.

AU - Rhee, Christopher J.

AU - Kupferman, Juan C.

AU - Bhutada, Alok

AU - Rastogi, Shantanu

AU - Ingraham, Susan

AU - Cole, F. Sessions

AU - Davis, T. Keefe

AU - Milner, Lawrence

AU - Smith, Alexandra

AU - Fuloria, Mamta

AU - Kaskel, Frederick J.

AU - Soranno, Danielle E.

AU - Gien, Jason

N1 - Funding Information: The authors would also like to thank the outstanding work of the following clinical research personnel and colleagues for their involvement in AWAKEN: Ariana Aimani, Samantha Kronish, Ana Palijan, MD, and Michael Pizzi—Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada. Laila Ajour, BS, Julia Wrona, BS—University of Colorado, Children’s Hospital Colorado, Aurora, Colorado. Melissa Bowman, RN—University of Rochester, Rochester, New York. Teresa Cano, RN, Marta G. Galarza, MD, Wendy Glaberson, MD, Aura Arenas Morales, MD, Denisse Cristina Pareja Valarezo, MD—Holtz Children’s Hospital, University of Miami, Miami, Florida. Sarah Cashman, BS, Madeleine Stead, BS—University of Iowa Children’s Hospital, Iowa City, Iowa. Jonathan Davis, MD, Julie Nicoletta, MD—Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts. Alanna DeMello—British Columbia Children’s Hospital, Vancouver, British Columbia, Canada. Lynn Dill, RN—University of Alabama at Birmingham, Birmingham, Alabama. Ellen Guthrie, RN—MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio. Nicholas L. Harris, BS, Susan M. Hieber, MSQM— C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan. Katherine Huang, Rosa Waters—University of Virginia Children’s Hospital, Charlottesville, Virginia. Judd Jacobs, Ryan Knox, BS, Hilary Pitner, MS, Tara Terrell— Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio. Nilima Jawale, MD—Maimonides Medical Center, Brooklyn, New York. Emily Kane—Australian National University, Canberra, Australia. Vijay Kher, DM, Puneet Sodhi, MBBS—Medanta Kidney Institute, The Medicity Hospital, Gurgaon, Haryana, India. Grace Mele—New York College of Osteopathic Medicine, Westbury, New York. Patricia Mele, DNP—Stony Brook Children’s Hospital, Stony Brook, New York. Charity Njoku, Tennille Paulsen, Sadia Zubair—Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas. Emily Pao—University of Washington, Seattle Children’s Hospital, Seattle, Washington. Becky Selman, RN, Michele Spear, CCRC—University of New Mexico Health Sciences Center Albuquerque, New Mexico. Melissa Vega, PA-C—The Children’s Hospital at Montefiore, Bronx, New York, USA. Leslie Walther, RN—Washington University, St. Louis, Missouri. Funding sources: Cincinnati Children’s Hospital Center for Acute Care Nephrology provided funding to create and maintain the AWAKEN Medidata Rave electronic database. The Pediatric and Infant Center for Acute Nephrology (PICAN) provided support for web meetings, for the NKC steering committee annual meeting at the University of Alabama at Birmingham (UAB), as well as support for some of the AWAKEN investigators at UAB (LJB., R.G.). PICAN is part of the Department of Pediatrics at the University of Alabama at Birmingham (UAB), and is funded by Children’s of Alabama Hospital, the Department of Pediatrics, UAB School of Medicine, and UAB’s Center for Clinical and Translational Sciences (CCTS, NIH grant UL1TR001417). Finally, the AWAKEN study at the University of New Mexico was supported by the Clinical and Translational Science Center (CTSC, NIH grant UL1TR001449) and by the University of Iowa Institute for Clinical and Translational Science (U54TR001356). C.L.A. was supported by the Micah Batchelor Foundation. A. A.A. and C.J.R. were supported by the Section of Pediatric Nephrology, Department of Pediatrics, Texas Children’s Hospital. J.R.C. and J.R.S. were supported by a grant from 100 Women Who Care. F.S.C. and K.T.D. were supported by the Edward Mallinckrodt Department of Pediatrics at Washington University School of Medicine. J.F. and A.K. supported by the Canberra Hospital Private Practice Fund. R.G. and E.R. were supported by the Department of Pediatrics, Golisano Children’s Hospital, University of Rochester. P.E.R. was supported by R01 HL-102497, R01 DK 49419. S.S. and D.T.S. were supported by the Department of Pediatrics & Communicable Disease, C.S. Mott Children’s Hospital, University of Michigan. S.S. and R.W. were supported by Stony Brook Children’s Hospital Department of Pediatrics funding. Publisher Copyright: © 2018, International Pediatric Research Foundation, Inc.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: In sick neonates admitted to the NICU, improper fluid balance can lead to fluid overload. We report the impact of fluid balance in the first postnatal week on outcomes in critically ill near-term/term neonates. Methods: This analysis includes infants ≥36 weeks gestational age from the Assessment of Worldwide Acute Kidney injury Epidemiology in Neonates (AWAKEN) study (N = 645). Fluid balance: percent weight change from birthweight. Primary outcome: mechanical ventilation (MV) on postnatal day 7. Results: The median peak fluid balance was 1.0% (IQR: −0.5, 4.6) and occurred on postnatal day 3 (IQR: 1, 5). Nine percent required MV at postnatal day 7. Multivariable models showed the peak fluid balance (aOR 1.12, 95%CI 1.08–1.17), lowest fluid balance in 1st postnatal week (aOR 1.14, 95%CI 1.07–1.22), fluid balance on postnatal day 7 (aOR 1.12, 95%CI 1.07–1.17), and negative fluid balance at postnatal day 7 (aOR 0.3, 95%CI 0.16–0.67) were independently associated with MV on postnatal day 7. Conclusions: We describe the impact of fluid balance in critically ill near-term/term neonates over the first postnatal week. Higher peak fluid balance during the first postnatal week and higher fluid balance on postnatal day 7 were independently associated with MV at postnatal day 7.

AB - Background: In sick neonates admitted to the NICU, improper fluid balance can lead to fluid overload. We report the impact of fluid balance in the first postnatal week on outcomes in critically ill near-term/term neonates. Methods: This analysis includes infants ≥36 weeks gestational age from the Assessment of Worldwide Acute Kidney injury Epidemiology in Neonates (AWAKEN) study (N = 645). Fluid balance: percent weight change from birthweight. Primary outcome: mechanical ventilation (MV) on postnatal day 7. Results: The median peak fluid balance was 1.0% (IQR: −0.5, 4.6) and occurred on postnatal day 3 (IQR: 1, 5). Nine percent required MV at postnatal day 7. Multivariable models showed the peak fluid balance (aOR 1.12, 95%CI 1.08–1.17), lowest fluid balance in 1st postnatal week (aOR 1.14, 95%CI 1.07–1.22), fluid balance on postnatal day 7 (aOR 1.12, 95%CI 1.07–1.17), and negative fluid balance at postnatal day 7 (aOR 0.3, 95%CI 0.16–0.67) were independently associated with MV on postnatal day 7. Conclusions: We describe the impact of fluid balance in critically ill near-term/term neonates over the first postnatal week. Higher peak fluid balance during the first postnatal week and higher fluid balance on postnatal day 7 were independently associated with MV at postnatal day 7.

UR - http://www.scopus.com/inward/record.url?scp=85056730559&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056730559&partnerID=8YFLogxK

U2 - 10.1038/s41390-018-0183-9

DO - 10.1038/s41390-018-0183-9

M3 - Article

C2 - 30237572

AN - SCOPUS:85056730559

SN - 0031-3998

VL - 85

SP - 79

EP - 85

JO - Pediatric Research

JF - Pediatric Research

IS - 1

ER -

The impact of fluid balance on outcomes in critically ill near-term/term neonates: a report from the AWAKEN study group

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