Early Fluid On The Outcome Of Severe Wet Lung In Late-preterm

Objective：To analysis the early fluid on the outcome of severe wet lung inlate-preterm, explore the appropriate early fluid, and provide reference fortherapy.Method：The clinical data of383cases were retrospectively analyzed, which weresevere wet lung in late-preterm and treated in our hospital from January in2008to December in2013. They were divided into3groups according to theaverage daily fluid in first3days after born: Group1(G1)：fluid between20ml/kg.d and39ml/kg.d, Group2(G2)： fluid between40ml/kg.d and59ml/kg.d, Group3(G3)： fluid more than60ml/kg.d. We observed thetreatment and prognosis in different groups respectively, mainly including:①X-ray change: wether there was a light transmittance reduce or effusion within3days.②Respiratory support: respiratory support time, initial respiratorysupport mode and the change of respiratory support mode later.③Urineoutput: average urine output of the first3days，oliguria group (average urineless than1ml/kg.h), normal group(average urine between1ml/kg.h and3ml/kg.h), urorrhagia group (average urine more than3ml/kg.h).④Weightchange: no physical weight loss group (weight loss less than8%of birthweight), physiological weight group (weight loss between8%and12%ofbirth weight), pathologic weight group (weight loss more than12%of birthweight).⑤Early complications: Respiratory distress syndrome, Acute pulmonary edema, Pneumothorax, Bronchi pulmonary dysphasia, Capillaryleak syndrome, Heart failure, Unconjugated hyperbilirubinemia,Hypoglycemia.⑥The duration of hospitalization. Statistical analysis：thechi-square test or Fisher’s exact was used to test the categorical data, theanalysis of variance and pairwise comparison were used to test themeasurement data with normal distribution， and the rank sum test andpairwise comparison for the continuous variables in skewed distribution. Teststandard α is0.05in the comparison of three groups, and it is significantdifferent when P<0.05，while test standard α＇is0.017in the comparisonbetween two groups, and it is significant different when P<0.017.Results:In the383cases, there was no significant difference on gestational age,birth weight, sex, and Patent ductus arteriosus (P value in the order:0.710,0.84,0.867,0.953). Difference existed between G1and G3(P<0.017) on theX-ray change, and between G2and G3(P<0.017) respectively. There was adifference between G2and G3(P<0.017) on respiratory support time. In thecomparison of initial respiratory support mode, G1had a higher percentage ofinvasive ventilation(19.2%). However, the percentage of G3changed fromnoninvasive ventilation to invasive ventilation later was more obvious(17.3%).Difference existed only between G1and G3(P<0.017) on the duration ofhospitalization. For the comparison of urine output, most infants of eachgroup had normal urine output. In terms of weight change, there weresignificant differences between every two groups (P<0.017). Besides, thecomparative analysis of the complications between groups： there weredifferences of the incidence of Respiratory distress syndrome, Acutepulmonary edema, Capillary leak syndrome, Heart failure (P<0.05), and theincidence rate of G3was higher than the other two groups. However, therewas no statistical difference of the incidence of Pneumothorax, Bronchi pulmonary dysphasia, Unconjugated hyperbilirubinemia, and Hypoglycemia(P＞0.05).Conclusion:1.To the late-preterm with severe wet lung, too much early fluid maycause edema of heart and lung, even lead to Capillary leak syndrome.2.Too much early fluid given to the late-preterm with severe wet lungmay prolong the time of respiratory support and the duration ofhospitalization.3.To the late-preterm with severe wet lung，moderate limitation of earlyfluid did not cause critical complications， such as Unconjugatedhyperbilirubinemia and Hypoglycemia.4.In order to ensure basic circulation and homeostasis, it is necessary tomonitor the clinical indicators, such as blood pressure, urine output andCapillary refill time in the limited fluid therapy to severe wet lung inlate-preterm.