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. 2014;2014(12):CD000503.
doi: 10.1002/14651858.CD000503.pub3. Epub 2014 Dec 4.

Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants

Edward F Bell  1 , Michael J Acarregui
Affiliations

Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants

Edward F Bell et al. Cochrane Database Syst Rev. 2014.

Abstract

Background: Most premature infants are physiologically not sufficiently mature to orally ingest all of their required water and nutrients. Therefore, premature infants rely on their caregivers to regulate their volume of water intake. Thus, the caregiver must determine the amount of water to be given each day to such infants.

Objectives: To determine the effect of water intake on postnatal weight loss and the risks of dehydration, patent ductus arteriosus, necrotizing enterocolitis, bronchopulmonary dysplasia, intracranial hemorrhage, and death in premature infants.

Search methods: Randomized clinical trials (RCTs) identified in previous versions of this review were re-examined and, in each case, retained. Additional trials were sought that compared the outcomes of interest in groups of premature infants who were given different levels of water intake according to an experimental protocol. Such trials were sought in a list of trials provided by the Cochrane Neonatal Review Group, with a PubMed search and in the authors' personal files.This search was updated in 2014.

Selection criteria: Only RCTs of varying water intake in premature infants were included. The review was limited to trials that included infants whose water intake was provided mainly or entirely by intravascular infusion.

Data collection and analysis: The standard methods of The Cochrane Collaboration were used. Study selection and data abstraction were performed independently by each review author. The adverse event rates were calculated for the restricted and liberal water intake groups for each dichotomous outcome, and the relative risk and risk difference were computed. In addition, the maximal weight loss results were recorded and the weighted mean difference was computed.

Main results: The analysis of the five studies taken together indicated that restricted water intake significantly increased postnatal weight loss and significantly reduced the risks of patent ductus arteriosus and necrotizing enterocolitis. With restricted water intake, there were trends toward increased risk of dehydration and reduced risks of bronchopulmonary dysplasia, intracranial hemorrhage, and death but these trends were not statistically significant.

Authors' conclusions: Based on this analysis, the most prudent prescription for water intake to premature infants would seem to be careful restriction of water intake so that physiological needs are met without allowing significant dehydration. This practice could be expected to decrease the risks of patent ductus arteriosus and necrotizing enterocolitis without significantly increasing the risk of adverse consequences.

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Conflict of interest statement

None

Figures

1.1
1.1. Analysis
Comparison 1 Restricted versus liberal water intake, Outcome 1 Weight loss (%).
1.2
1.2. Analysis
Comparison 1 Restricted versus liberal water intake, Outcome 2 Dehydration.
1.3
1.3. Analysis
Comparison 1 Restricted versus liberal water intake, Outcome 3 Patent ductus arteriosus.
1.4
1.4. Analysis
Comparison 1 Restricted versus liberal water intake, Outcome 4 Necrotizing enterocolitis.
1.5
1.5. Analysis
Comparison 1 Restricted versus liberal water intake, Outcome 5 Bronchopulmonary dysplasia.
1.6
1.6. Analysis
Comparison 1 Restricted versus liberal water intake, Outcome 6 Intraventricular hemorrhage (all grades).
1.7
1.7. Analysis
Comparison 1 Restricted versus liberal water intake, Outcome 7 Death.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Bell 1980 {published data only}
    1. Bell EF, Warburton D, Stonestreet BS, Oh W. Effect of fluid administration on the development of symptomatic patent ductus arteriosus and congestive heart failure in premature infants. New England Journal of Medicine 1980;302:598‐604. [MEDLINE: ] - PubMed
    1. Bell EF, Warburton D, Stonestreet BS, Oh W. High‐volume fluid intake predisposes premature infants to necrotising enterocolitis. Lancet 1979;2:90. [MEDLINE: ] - PubMed
Kavvadia 2000 {published data only}
    1. Kavvadia V, Greenough A, Dimitriou G, Forsling ML. Randomized trial of two levels of fluid input in the perinatal period ‐‐ effect on fluid balance, electrolyte and metabolic disturbances in ventilated VLBW infants. Acta Paediatrica 2000;89:237‐41. [MEDLINE: ] - PubMed
    1. Kavvadia V, Greenough A, Dimitriou G, Hooper R. Comparison of the effect of two fluid input regimens on perinatal lung function in ventilated very low birthweight infants. European Journal of Pediatrics 1999;158:917‐22. [MEDLINE: ] - PubMed
    1. Kavvadia V, Greenough A, Dimitriou G, Hooper R. Randomised trial of fluid restriction in ventilated very low birthweight infants. Archives of Disease in Childhood. Fetal and Neonatal Edition 2000;83:F91‐6. [MEDLINE: ] - PMC - PubMed
Lorenz 1982 {published data only}
    1. Lorenz JM, Kleinman LI, Kotagal UR, Reller MD. Water balance in very low‐birth‐weight infants: relationship to water and sodium intake and effect on outcome. Journal of Pediatrics 1982;101:423‐32. [MEDLINE: ] - PubMed
    1. Reller MD, Lorenz JM, Kotagal UR, Meyer RA, Kaplan S. Hemodynamically significant PDA: an echocardiographic and clinical assessment of incidence, natural history, and outcome in very low birth weight infants maintained in negative fluid balance. Pediatric Cardiology 1985;6:17‐24. [MEDLINE: ] - PubMed
Tammela 1992 {published data only}
    1. Tammela OKT, Koivisto ME. Fluid restriction for preventing bronchopulmonary dysplasia? Reduced fluid intake during the first weeks of life improves the outcome of low‐birth‐weight infants. Acta Paediatrica 1992;81:207‐12. [MEDLINE: ] - PubMed
    1. Tammela OKT, Lanning FP, Koivisto ME. The relationship of fluid restriction during the 1st month of life to the occurrence and severity of bronchopulmonary dysplasia in low birth weight infants: a 1‐year radiological follow up. European Journal of Pediatrics 1992;151:295‐9. [MEDLINE: ] - PubMed
    1. Tammela OKT, Lanning FP, Koivisto ME. The relationship of fluid restriction during the 1st month of life to the occurrence and severity of bronchopulmonary dysplasia in low birth weight infants: a 1‐year radiological follow up. European Journal of Pediatrics 1992;151:367‐71. [MEDLINE: ] - PubMed
von Stockhausen 1980 {published data only}
    1. Stockhausen HB, Struve M. Die Auswirkungen einer stark unterschiedlichen parenteralen Flussigkeitszufuhr bei Fruh‐ und Neugeborenen in den ersten drei Lebenstagen. Klinische Pädiatrie 1980;192:539‐46. [MEDLINE: ] - PubMed

References to studies excluded from this review

Stroustrup 2012 {published data only}
    1. Stroustrup A, Trasande L, Holzman IR. Randomized controlled trial of restrictive fluid management in transient tachypnea of the newborn. Journal of Pediatrics 2012;160(1):38‐43. [DOI: 10.1016/j.jpeds.2011.06.027; PUBMED: 21839467] - DOI - PMC - PubMed

Additional references

Bell 1978
    1. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, Brotherton T. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Annals of Surgery 1978;187(1):1‐7. - PMC - PubMed
Bell 1992
    1. Bell EF. Fluid therapy. In: Sinclair JC, Bracken MB editor(s). Effective Care of the Newborn Infant. Oxford: Oxford University Press, 1992:59‐72.
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. Available from www.cochrane‐handbook.org.
Papile 1978
    1. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. Journal of Pediatrics 1978;92(4):529‐34. - PubMed

References to other published versions of this review

Bell 1998
    1. Bell EF, Acarregui M. Restricted versus liberal water intake for the prevention of morbidity and mortality in preterm infants. Cochrane Database of Systematic Reviews 1998, Issue 4. [DOI: 10.1002/14651858.CD000503] - DOI
Bell 2001
    1. Bell EF, Acarregui MJ. Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants. Cochrane Database of Systematic Reviews 2001, Issue 3. [DOI: 10.1002/14651858.CD000503] - DOI - PubMed
Bell 2008
    1. Bell EF, Acarregui MJ. Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants. Cochrane Database of Systematic Reviews 2008, Issue 4. [DOI: 10.1002/14651858.CD000503.pub2] - DOI - PubMed

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