Early feeding and fluid volume associations with adverse in-hospital outcomes among premature newborns.

Abstract

High average total fluid intakes in the first week after birth are linked to adverse outcomes in preterm infants, including necrotizing enterocolitis (NEC) and bronchopulmonary dysplasia (BPD). Relative contributions of enteral and parenteral fluids remain unclear. Evaluate associations between average enteral, parenteral, and total fluid intake in the first postnatal week and morbidity and mortality in preterm newborns. In this retrospective study of 185 infants born ≤30 weeks or ≤1250 g who survived seven days in a level IV NICU, we assessed relationships between fluid intake and adverse outcomes, including mortality, length of stay (LOS), NEC, and BPD. Each 10 mL/kg/day increase in enteral intake averaged over the first postnatal week was associated with 30% lower odds of BPD, 35% lower odds of mortality (aOR 0.70, 95% CI 0.58-0.85; aOR 0.65, 95% CI 0.46-0.93), and shorter LOS (-4.77 days, 95% CI -7.26, -2.29). Higher average enteral feeds were not associated with adverse outcomes. Higher average parenteral and total fluid intakes were associated with increased odds of BPD, mortality, and prolonged LOS. Higher average enteral intake in the first week is associated with improved outcomes in preterm infants. Previous research on extremely low birthweight infants reported that high total fluid intake within the first week after birth is associated with increased risk of adverse outcomes The relative contributions of parenteral fluid versus enteral feeding volumes have not been evaluated. Among neonates born at ≤30 gestational weeks or ≤1250 g, higher enteral intake was associated with decreased odds of mortality, bronchopulmonary dysplasia, and a shorter length of stay. Higher parenteral fluid intake and higher total fluid intake were associated with increased odds of adverse outcomes.