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

Nima Naseh; Edward F Bell; Richard Sindelar; Lena Hellström Westas; Johan Ågren

doi:10.1016/j.jpeds.2025.114661

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

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

Nima Naseh, Edward F Bell, Richard Sindelar, Lena Hellström Westas and Johan Ågren

The Journal of pediatrics, Vol.284, 114661

09/2025

DOI: 10.1016/j.jpeds.2025.114661

PMID: 40389134

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Abstract

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. 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. 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). 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.

hyperglycemia

immaturity

extreme prematurity

hypernatremia

Acute kidney injury

insensible water loss

skin

dehydration

Details

Title: Subtitle: Fluid Balance in Infants born at 22-23 Weeks' Gestation: Trajectories and Associations with Outcomes
Creators: Nima Naseh - Uppsala University
Edward F Bell - University of Iowa
Richard Sindelar - Uppsala University
Lena Hellström Westas - Uppsala University
Johan Ågren - Uppsala University
Resource Type: Journal article
Publication Details: The Journal of pediatrics, Vol.284, 114661
DOI: 10.1016/j.jpeds.2025.114661
PMID: 40389134
NLM abbreviation: J Pediatr
ISSN: 1097-6833
eISSN: 1097-6833
Publisher: MOSBY-ELSEVIER
Grant note: Gillbergska FoundationRegion Uppsala
Nima Naseh reports that financial support was provided by Gillbergska Foundation and Region Uppsala. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Language: English
Electronic publication date: 05/17/2025
Date published: 09/2025
Academic Unit: Stead Family Department of Pediatrics; Neonatology
Record Identifier: 9984824138502771

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