Fluid and Electrolyte Balance During the First Week of Life and Risk of Bronchopulmonary Dysplasia in the Preterm Neonate

Abstract

BACKGROUND:Early fluid and electrolyte imbalances may be associated with an increased risk of bronchopulmonary dysplasia.OBJECTIVE:We sought to establish an association between fluid and electrolyte balance in the first week of life and the risk of bronchopulmonary dysplasia.METHODS:Clinical charts of 205 neonates <32 weeks gestational age and/or <1,250 g birth weight (admitted to our NICU between 1997 and 2008) were analyzed. Clinical features, fluid and electrolyte balance were analyzed for the first 7 days of life using multivariate models of generalized estimation equations. A p value <0.05 was considered significant in all of the hypothesis tests.RESULTS:The prevalence of bronchopulmonary dysplasia was 22%. Lower gestational age and birth weight, male gender, less frequent use of antenatal steroids, respiratory distress syndrome, use of surfactant, patent ductus arteriosus, duration of invasive ventilation and NICU stay were significantly associated with bronchopulmonary dysplasia. The variation in serum values of potassium, phosphorus and creatinine during the first week of life also revealed an association with bronchopulmonary dysplasia. Higher mean plasma calcium values were associated with spontaneous closure of the patent ductus arteriosus. The use of indomethacin to induce patent ductus arteriosus closure was significantly higher in bronchopulmonary dysplasia patients.CONCLUSIONS:Differences in renal function and tubular handling of potassium and phosphorus are present during the first week of life among preterm neonates who will develop bronchopulmonary dysplasia. The higher rate of patent ductus arteriosus and indomethacin use may influence these differences. Serum levels of calcium also appear to play a role in spontaneous ductus arteriosus closure.

Acute kidney injury is associated with bronchopulmonary dysplasia/mortality in premature infants

“…Others have noted a similar effect of fluid provision and clinical outcomes, but have used different surrogate markers of fluid homeostasis [22, 23]. Because fluid provision is a potentially modifiable risk factor and there is wide clinical practice variance on the amount of fluid prescribed to premature infants, this observation needs to be further explored.…”

“…In 2005, Oh et al reported the association between fluid intake and weight loss during the first 10 days of life and the risk of BPD in extremely low birth weight infants [22]. In 2010, Rocha et al showed an association between fluid and electrolyte balance in the first week of life and the risk of BPD in preterm neonates [23]. …”

Pesquisas em pneumologia recentemente publicadas em revistas brasileiras

“…Rocha et al (22) found that differences in renal function and tubular handling of potassium and phosphorus are present during the first week of life among preterm neonates who will develop bronchopulmonary dysplasia. The authors also found that patent ductus arteriosus and increased indomethacin use accentuate those differences.…”

Changes in Serum Creatinine Levels and Natural Evolution of Acute Kidney Injury with Conservative Management of Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants at 23–26 Weeks of Gestation

“…Assessing kidney function is crucial for meticulous fluid, electrolyte, and nutritional support, and the adjustment of medication dosage in extremely preterm infants (EPT) [1][2][3][4]. Serum creatinine level (sCr) is a commonly used in evaluating renal function and could also be applied in assessment of glomerular filtration rate (GFR) in neonates and infants [4][5][6][7].…”

“…AKI in premature infants are known to be related to increased mortality [11,[17][18][19][20][21] and morbidities, which includes bronchopulmonary dysplasia (BPD) [2,22,23] and intraventricular hemorrhage (IVH) [24]. However, these associations have not been well reported and elucidated in EPT, although J. Clin.…”