Fluid overload in newborns undergoing abdominal surgery: a retrospective study

Abstract

Background

Fluid management in newborns undergoing surgery can be challenging due to difficulties in accurately assessing volume status in context of high fluid needs perioperatively and postoperative third-space fluid loss. Fluid overload can be associated with an increase in neonatal morbidity and mortality.

Objective

Our objective was to determine the burden of fluid overload and to evaluate their associations with adverse effects among infants undergoing abdominal surgery at a tertiary perinatal center.

Methods

Patients from our Neonatal Intensive Care Unit who underwent abdominal surgery from January 2017 to June 2019 were included in this retrospective cohort study. Fluid balance was assessed based on the maximum percentage change in body weight at 3- and 7-postoperative days.

Results

Sixty infants were included, with a median [interquartile range] gestational age (GA) of 29 [25–36] weeks and birth weight of 1240 [721–2871] grams. The median daily actual fluid intake was significantly higher than the prescribed fluid intake in the first 7 postoperative days (163 vs. 145 mL/kg, p < .01). The median maximum change of body weight by postoperative days 3 and 7 were 6% [3–13] and 11% [5–17], respectively. A 1% increase in weight within the first 3 postoperative days was associated with a 0.6-day increase for invasive ventilatory support (p = .012). The correlation was still significant after adjusting for GA (p = .033).

Conclusion

Fluid overload within the first 3 postoperative days was associated with an increase in ventilator support among infants. Careful attention to fluid management may affect the optimization of outcomes for newborns undergoing abdominal surgery.

Keywords:

• Neonate
• surgery
• fluid
• ventilation
• preterm

Acknowledgments

We are grateful to Ms. Jessica Tang for her editorial support regarding the completion and submission of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s). The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Data availability statement

The database for this research article is not available because of identifiable patient particulars in a relatively small number of patients.

Additional information

Funding

JT was supported by the Investigator Grant Award Program from British Columbia Children's Hospital Research Institute (BCCHR) during 2017–2021. BCCHR has no role in the conduction of this study and manuscript production.