Neonatal fluid overload-ignorance is no longer bliss

Abstract

Excessive accumulation of fluid may result in interstitial edema and multiorgan dysfunction. Over the past few decades, the detrimental impact of fluid overload has been further defined in adult and pediatric populations. Growing evidence highlights the importance of monitoring, preventing, managing, and treating fluid overload appropriately. Translating this knowledge to neonates is difficult as they have different disease pathophysiologies, and because neonatal physiology changes rapidly postnatally in many of the organ systems (i.e., skin, kidneys, and cardiovascular, pulmonary, and gastrointestinal). Thus, evaluations of the optimal targets for fluid balance need to consider the disease state as well as the gestational and postmenstrual age of the infant. Integration of what is known about neonatal fluid overload with individual alterations in physiology is imperative in clinical management. This comprehensive review will address what is known about the epidemiology and pathophysiology of neonatal fluid overload and highlight the known knowledge gaps. Finally, we provide clinical recommendations for monitoring, prevention, and treatment of fluid overload.

Keywords: Acute kidney injury; Dialysis; Fluid; Fluid overload; Infant; Kidney; Kidney support therapy; Mortality; Neonate; Newborn; Preterm.

Fig. 1

The total body water shifts that occur with intracellular and extracellular fluid throughout gestation and into infancy. Re-printed with permission. Bell EF, Segar JL, William O (2016) Fluid and Electrolyte Management. https://obgynkey.com/fluid-and-electrolyte-management/. Accessed 15 November 2021