Individualized fluid management in extremely preterm neonates to ensure adequate diuresis without increasing complications.

Objective: Decrease the incidence of inadequate diuresis (ID, loss of <6% of birth weight) in extremely preterm neonates (EPT, <28 weeks of gestation at birth) during the first week of life by 50% in 1 year.

Study Design: Quality improvement project in a level IV neonatal intensive care unit. A fluid management protocol was implemented, including the use of a fluid guide sheet and closer monitoring of hydration parameters. Seventy-nine baseline EPT neonates were compared to 83 post intervention. The incidence of ID was tracked monthly, along with prespecified morbidities and complications. Statistical data analyses also compared the pre- and post-intervention periods.

Results: Fluid volumes in the first week were decreased (p < 0.001). ID decreased from 43 to 29% (p = 0.061). Tracked morbidities and complications were not statistically different.

Conclusion: Intentional and individualized adjustment of fluids led to decreased ID without increased hypernatremia and dehydration, or a change in tracked morbidities.