Influence of early fluid overload on bronchopulmonary dysplasia in very low-birth-weight infants

ObjectiveThis study aimed to determine the influence of fluid overload on bronchopulmonary dysplasia (BPD) in very low-birth-weight infants (VLBWI) within 1 week after birth. MethodsThis was a retrospective case control study conducted in the Jingzhou Central Hospital. The clinical data of VLBWI (with a birth weight [BW] < 1,500 g and 26 weeks <= gestational age [GA] < 32 weeks) who were admitted to the neonatal intensive care unit of this hospital from January 2016 to December 2021 were analyzed retrospectively. A total of 157 cases were enrolled and divided into a BPD group (n = 60) and a non-BPD group (n = 97) according to whether BPD was present. The general condition, fluid intake, and fluid overload of the two groups of neonates within 1 week after birth were compared. The logistic regression was used to assess the association between infant characteristics and BPD. The ROC curve was used to assess how well the 7 day cumulative fluid overload predicted BPD, and to identify an optimal cut off for prediction. ResultsThe comparison of the patients' general condition revealed that the neonates in the BPD group had a younger GA, lower BW, lower 5-min Apgar score, longer duration of invasive mechanical ventilation, and higher incidence of intrauterine infections and administration of surfactants (P < 0.05). The differences in the other indicators were not statistically significant between the two groups. The logistic regression analysis revealed that a younger GA, the presence of intrauterine infection, and a 7-day cumulative fluid overload were the risk factors for the development of BPD. A ROC curve was plotted with the 7-day cumulative fluid overload as the test variable and BPD as the status variable. The area under the curve was 0.75 (95% confidence interval: 0.664-0.826, P = 0.042), with a sensitivity of 76.7% and a specificity of 70.1%, corresponding to a 7-day cumulative fluid overload of 36.2%. ConclusionA younger GA, the presence of intrauterine infection, and a 7-day cumulative fluid overload were risk factors for the development of BPD. A 7 day cumulative fluid overload threshold of 36.2% best predicted the development of BPD.