739 - Evaluation of First-Week Fluid Intake (Total, Parenteral, and Enteral) and Maximal Weight Loss Percentage with In-Hospital Adverse Outcomes among Moderately Preterm Newborns in Addis Ababa, Ethiopia

Publication Number: 739.4701

Gregory C.. Valentine, University of Washington School of Medicine, Tacoma, WA, United States; Tessa Rue, University of Washington, Seattle, WA, United States; Olivia C. Brandon, University of Washington: Magnuson Health Sciences Center – RR 544A, Seattle, WA, United States; Krystle M.. Perez, University of Washington, Seattle, WA, United States; Thomas R. Wood, University of Washington School of Medicine, Seattle, WA, United States; Gal Barbut, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Sharla Rent, Duke University School of Medicine, Durham, NC, United States; Merhawit Abadi, Saint Paul's Hospital Millennium Medical College, ADDIS ABABA, Adis Abeba, Ethiopia; Redeat Workneh, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia, Adis Abeba, Ethiopia; Mahlet Abayneh, St Paul's Hospital Millennium Medical College, Addis ABABA, Adis Abeba, Ethiopia

Background: Recent studies have reported that maximal weight loss (MWL) >15% and increasing first-week total fluid administration (TFA) among extremely preterm neonates in the United States is associated with adverse health outcomes. It is uncertain if these findings remain true in low- and middle-income country (LMIC) settings, and whether first-week enteral and parenteral fluid intake have similar effects on outcomes.

Objective: To evaluate the relationship between first week MWL and average TFA, enteral intake, and parenteral intake and adverse in-hospital outcomes at the St. Paul’s Hospital Millennium Medical College (SPHMMC) neonatal intensive care unit (NICU) in Ethiopia.

Design/Methods: We evaluated newborns born < 34 weeks’ gestation or < 1,500 grams who survived 7 days. We performed unadjusted analyses for first-week MWL, average TFA, average parenteral, and average enteral fluid intake and relationship with mortality. Using unadjusted analyses, we determined categorical cut-offs where the confidence intervals for mortality proportion no longer included 0. Categories were evaluated for adverse outcomes through logistic and linear regression models after adjusting for confounders.

Results: Among n=661 moderately preterm (MP) newborns increasing percent MWL, increasing average TFA, increasing average parenteral fluid intake, and decreasing enteral fluid intake over the first week were associated with increased odds of mortality (Figure 1). After adjusting for known confounders, MWL of >13% was associated with significantly increased odds of suspected necrotizing enterocolitis, culture positive sepsis, retinopathy of prematurity (ROP), and length of stay (LOS; Figure 2). Average first week TFA >110 mL/kg/day was associated with increased risk of culture-positive sepsis, ROP and LOS with a trend towards increased overall mortality (Figure 2). Average enteral intake of >60 mL/kg/day was significantly associated with 71% reduced odds of mortality, 81% reduced odds of culture-positive sepsis, 71% reduced odds of ROP, and a 30% reduced LOS. Average parenteral intake of >60 mL/kg/day was associated with increased odds of all adverse in-hospital outcomes, including nearly 10-fold increased odds of mortality (Figure 3).

Conclusion(s): In MP neonates in an LMIC setting, >13% MWL is associated with adverse health outcomes. While increasing average TFA over the first week is also associated with adverse health outcomes, the effect is driven by parenteral intake rather than enteral intake. Future studies should explore the impact of exclusive enteral intake among MP neonates in LMICs.

Figure 1: Unadjusted analyses comparing first-week (A) maximal weight loss percentage, (B) average total fluid administration (TFA), (C) average enteral intake, and (D) average parenteral intake with proportion of mortality.


Figure 2: Multivariate Adjusted Logistic and Linear Regression Models Comparing (A) Maximal Weight Loss (MWL) Percentage and (B) Average First-Week Total Fluid Administration (TFA) with Adverse In-Hospital Outcomes.
MWL categories were ≤13% or >13% and TFA categories were ≤110 mL/kg birthweight/day or >110 mL/kg birthweight/day and selected based on the unadjusted models (Figure 1) where the confidence intervals did not cross 0 for the proportion for death. NEC: Necrotizing enterocolitis; ROP: Retinopathy of Prematurity; LOS: Length of stay

Figure 3: Multivariate Adjusted Logistic and Linear Regression Models Comparing (C) Average First-Week Enteral Intake and (D) Average First-Week Parenteral Intake with Adverse In-Hospital Outcomes.
Categories were ≤60 mL/kg birthweight/day or >60 mL/kg birthweight/day for both first-week average enteral and parenteral intake and selected based on the unadjusted models (Figure 1) where the confidence intervals did not cross 0 for the proportion for death. Of note, whereas nearly all adverse outcomes were significantly associated with average enteral intake of ≤60 mL/kg birthweight/day over the first week, the opposite was true with average parenteral intake with >60 mL/kg birthweight/day being uniformly associated with all adverse in-hospital outcomes. NEC: Necrotizing enterocolitis; ROP: Retinopathy of Prematurity; LOS: Length of stay