Correlation Between Early Fluid Load And Complications In Very Low Birth Weight Infants

Objective: To analyze the effect of early fluid load on related complications of very low birth weight infants(VLBWI)in our hospital and explore its pathogenesis Method:The medical records of VLBWIs(birth weight < 1500 g and gestational age < 37 weeks)admitted to the neonatal intensive care unit(NICU)in Jingzhou Central Hospital of the Second Clinical Medical College of Yangtze University between January 2016 and December 2021 were retrospectively analyzed.This study is divided into two parts.The first part takes VLBW with birth weight<1500g,gestational age<32 weeks,and meets the inclusion and exclusion criteria as the study object.According to the presence or absence of bronchopulmonary dysplasia(BPD),it is divided into BPD group and the non-bronchopulmonary dysplasia(NBPD)group.The general situation,drug use during hospitalization,respiratory and circulatory support and complications,fluid intake and fluid load in the first week after birth were compared between the two groups.logistic regression was used to determine the correlation between early liquid load and BPD,and receiver operating characteristic curve(ROC)was plotted to determine the threshold of fluid overload(FO).In the second part,taking the optimal FO threshold for BPD determined in the first part of the study as the critical value,all children with birth weight<1500g,gestational age<37 weeks and meeting the inclusion and exclusion criteria were re-grouped,and divided into FO group and non-fluid overload(NFO)group.The general situation,drug use,respiratory circulation support and complications during hospitalization were recorded in the 2 groups.To observe the effect of FO on other related complications of VLBWI.The above studies were statistically analyzed by independent sample t-test,chi-square test,rank sum test,Fisher exact probability method and binary logistic regression analysis.Result: Part I:(1)A total of 273 Vl BWIs admitted to NICUs during the study period,and 157 cases were eventually included in the study,including 60 cases in BPD group and 97 cases in NBPD group.(2)The comparison of VLBWI general situation,drug use during hospitalization,respiratory circulation support and occurrence of complications between the two groups showed that gestational age,birth weight and 5-minute Apgar score at birth in the BPD group were lower,invasive mechanical ventilation time was longer,and the incidence of intrauterine infection and the use of surface active drugs was higher(P < 0.05).The rest were not statistically significant.(3)In the comparison of fluid status of VLBWI between the two groups,the 3d accumulated fluid load and the7 d accumulated fluid load in the BPD group were significantly higher than those in the NBPD group(P<0.001).(4)logistic regression analysis showed that small gestational age,intrauterine infection and cumulative fluid load at 7 days were independent risk factors for BPD.(5)The ROC curve is drawn with the 7d cumulative fluid load as the test variable and BPD as the state variable.The area under the curve is 0.75(95% CI:0.664～0.826,P=0.042).The sensitivity and specificity are 76.7% and 70.1%respectively,and the corresponding 7d cumulative fluid load is 36.2%.Part II:(1)198cases of VLBW children were included,including 101 cases in FO group and 97 cases in NFO group.(2)There were no significant differences in the general situation of VLBWI and drug use during hospitalization between the two groups(P > 0.05).The utilization rate of ventilator during hospitalization in FO group was higher than that in NFO group,the difference was statistically significant(P < 0.05).(3)The incidence of hemodynamically abnormal patent ductus arteriosus(hs PDA),late-onset sepsis(LOS)and pneumonia(PN)in FO group was higher than that in NFO group,with statistically significant difference(P<0.05).There was no significant difference in the incidence of necrotizing enterocolitis(NEC),intraventricular hemorrhage(IVH)and pulmonary hemorrhage(PH)between the two groups(P>0.05).(4)logistic regression analysis showed that compared with NFO group,FO group could increase the risk of hs PDA(P:0.030;OR:4.225;95% CI: 1.154～15.470),LOS(P: 0.020;OR:2.358;95% CI:1.134～4.901),PN(P: 0.006;OR:4.263;95% CI: 1.523～11.932),the differences were statistically significant.Conclusion: Cumulative fluid load at 7 days,small gestational age and intrauterine infection were independent risk factors for BPD.The occurrence of BPD should be vigilant when the cumulative fluid load of 7 days is ≥ 36.2%.The incidence of fluid overload(7 days cumulative fluid load ≥ 36.2%)in very low birth weight infants(gestational age<37 weeks)in our hospital is 51.0%.Fluid overload in the early postnatal period is also a risk factor for the occurrence of hs PDA,LOS and PN in very low birth weight infants.