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. 2021 Feb;41(2):240-246.
doi: 10.1038/s41372-020-00789-7. Epub 2020 Aug 19.

Individualized fluid management in extremely preterm neonates to ensure adequate diuresis without increasing complications

Jaclyn Havinga  1 , Allison Williams  2 , Neha Hassan  3 , Shannon Moore  3 , Emma Dollhopf  3 , Dmitry Tumin  2 , Uduak S Akpan  2
Affiliations

Individualized fluid management in extremely preterm neonates to ensure adequate diuresis without increasing complications

Jaclyn Havinga et al. J Perinatol. 2021 Feb.

Abstract

Objective: Decrease the incidence of inadequate diuresis (ID, loss of <6% of birth weight) in extremely preterm neonates (EPT, <28 weeks of gestation at birth) during the first week of life by 50% in 1 year.

Study design: Quality improvement project in a level IV neonatal intensive care unit. A fluid management protocol was implemented, including the use of a fluid guide sheet and closer monitoring of hydration parameters. Seventy-nine baseline EPT neonates were compared to 83 post intervention. The incidence of ID was tracked monthly, along with prespecified morbidities and complications. Statistical data analyses also compared the pre- and post-intervention periods.

Results: Fluid volumes in the first week were decreased (p < 0.001). ID decreased from 43 to 29% (p = 0.061). Tracked morbidities and complications were not statistically different.

Conclusion: Intentional and individualized adjustment of fluids led to decreased ID without increased hypernatremia and dehydration, or a change in tracked morbidities.

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