March 2026: Early fluid status and severe intraventricular hemorrhage or death in extremely preterm infants
March 2026
Early fluid status and severe intraventricular hemorrhage or death in extremely preterm infants
Article Authors: Lucinda J. Weaver, Samuel J. Gentle, Arie Nakhmani, Fazlur Rahman, Namasivayam Ambalavanan, Vivek V. Shukla, Christine Stoops, David Askenazi, Colm P. Travers
Journal citation: Pediatr Nephrol 41, 239247 (2026). https://doi.org/10.1007/s00467-025-06962-4
Reviewer name: Elizabeth Rivas
Purpose of the study: This study aimed to evaluate markers of fluid status in extremely preterm infants and the association to severe intraventricular hemorrhage (sIVH) or death.
Study Design: This was a retrospective, single-center cohort study that looked at neonates weighing ³ 400g born between 22- and 27-weeks gestation between 2014 and 2021. Fluid status markers were collected for the first seven days of life and included serum sodium, percent weight change, total fluid intake, urine output, and fluid balance [(daily weight birth weight)/birth weight x100]. The primary outcome was the development of sIVH (defined as grade 3 or grade 4 IVH) or death within the first seven days of life. Multiple regression and machine learning models were utilized to help predict these outcomes.
Population characteristics: There were 932 infants included in the study with a mean gestational age of 25w2d ± 11 days and birth weight of 746 ± 212g. 195 infants (20.9%) developed sIVH and/or death within the first seven days of life.
Study Results: Those with development of sIVH and/or death had a lower gestational age and birth weight and were more likely to be born via cesarean section. They had a less negative fluid balance (-10.6% vs -13.7%) in the first week or peaked at a higher fluid balance of 2% vs 0.2%. A higher average daily sodium and higher total fluid intake was associated with sIVH and/or death, with the group that developed sIVH and/or death receiving on average 15-20mL/kg/d more fluid over the first week than the infants who survived without sIVH.
Implications: Infants that developed sIVH and/or death in this single-center analysis lost less weight, received more fluid, and had a higher sodium than those who survived without sIVH. This suggests that close monitoring of fluid markers in the first week, focusing on reducing fluid overload and hypernatremia, could help lower the risk of sIVH and/or death in these infants.