Evaluation of First-Week Fluid Intake and Maximal Weight Loss Percentage with In-Hospital Adverse Outcomes Among Moderately and Very Preterm Newborns in Ethiopia

TL;DR

This study finds that high weight loss and parenteral fluid intake in preterm babies in Ethiopia are linked to worse health outcomes, while higher enteral intake improves outcomes.

Contribution

The study identifies specific thresholds for weight loss and fluid intake associated with adverse outcomes in preterm neonates in low- and middle-income countries.

Findings

More than 13% maximal weight loss is linked to higher odds of NEC, sepsis, ROP, and longer hospital stays.

Enteral intake above 60 mL/kg/day reduces odds of mortality, NEC, sepsis, ROP, and shortens hospital stays.

Parenteral intake above 60 mL/kg/day increases odds of mortality, sepsis, ROP, and longer hospital stays.

Abstract

Background/Objective: We sought to address ongoing gaps in understanding the relationship between first-week percent maximal weight loss (MWL) and average first-week total fluid intake (TFI), enteral intake, and parenteral intake among premature newborns with adverse in-hospital outcomes born in low- and middle-income countries (LMICs). Methods: We evaluated newborns born <34 weeks gestation or <1500 g who survived at least 7 days at the St. Paul’s Hospital Millennium Medical College (SPHMMC) neonatal intensive care unit in Ethiopia. We performed univariate and multivariate regression models analyzing the first-week MWL, average TFI, parenteral, and enteral intake and their relationships with adverse in-hospital outcomes. Results: Among N = 490 moderately and very preterm newborns, multivariate regression models demonstrated that >13% MWL was associated with significantly increased odds of suspected necrotizing enterocolitis (NEC), culture-positive sepsis, retinopathy of prematurity (ROP), and a longer length of stay (LOS). An average enteral intake of >60 mL/kg/day was significantly associated with reduced odds of all-cause mortality, suspected NEC, culture-positive sepsis, ROP, and a shorter LOS, whereas an average parenteral intake of >60 mL/kg/day was associated with increased odds of in-hospital mortality, culture-positive sepsis, ROP, and a longer LOS. Conclusions: In moderately and very preterm neonates in an LMIC setting, >13% MWL is associated with adverse health outcomes. Increasing the average parenteral intake over the first week after birth among moderately and very preterm neonates is significantly associated with adverse in-hospital outcomes whereas increasing the average enteral intake is associated with improved outcomes.

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