ArticlePediatric research2026
Reducing NICU ventilator days by preventing fluid overload with the CAN-U-P-LOTS standardized bundle.
Article in Pediatric research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Time to diagnosis of acute kidney injury and its predictors among outborn neonates in India: a competing-risk analysis of tele-ICU network data (2022-2024).The Lancet regional health. Southeast Asia · 2026Article
- Weight changes and variability in the first week of life: associations with mortality in extremely preterm newborns.Pediatric nephrology (Berlin, Germany) · 2026Article
- A Pathophysiological Approach for Early Detection and Prevention of AKI in the NICU.American journal of perinatology · 2026Review
- From Gestational Age-Specific Serum Creatinine Trajectories to an Interactive Clinical Interpretation Tool in Level IV NICU Infants.Research square · 2026Article
- Bridging evidence and practice: implementation science and bundled care strategies for fluid management in critically ill neonates.Frontiers in medicine · 2026Article
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Authors and funding
11 authors.
Funding
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Abstract
backgroundFluid overload in critically ill neonates and infants is associated with higher ventilation days, prolonged length of stay, and mortality.
methodsThis quality improvement study enrolled infants admitted to Children's of Alabama NICU (excluding those with tracheostomies, severe congenital kidney or heart disease, DNR status, or severe genetic conditions). We compared 7 months of pre-intervention data (211 neonates) with 7 months of post-implementation data (218 neonates). Bundle implementation for at least 5 days occurred for sepsis, spontaneous intestinal perforation, necrotizing enterocolitis, acute kidney injury, positive fluid balance >10%, hypotension, and major surgeries. The primary hypothesis was that the unit-wide ventilator-free days would increase after bundle implementation.
resultsWe found special cause variation with an increase in the percentage of ventilator-free and oxygen-free days coinciding with bundle introduction. The ventilator-free days were higher in the post-era compared to the pre-era (5592/8335 (67%) vs. (3732/6619) (56%); p < 0.001). Oxygen-free days and NICU length of stay showed similar findings.
conclusionsImplementation of a fluid overload prevention bundle was associated with increased ventilator-free days, oxygen-free days, and shortened NICU duration. Additional studies are needed to better understand these associations and externally validate our hypothesis in other populations. IMPACT: Fluid overload leads to poor clinical outcomes, including the need for ventilatory support. Prolonged ventilation has a deleterious effect on the lungs due to barotrauma and leads to complications (i.e., pneumonia), longer length of stay, and increased costs. After consensus from a multi-disciplinary team, we implemented a strategy using the CAN-U-P-LOTS bundle designed to prevent fluid overload in critically ill infants. We showed an increase in the number of ventilator-free days, oxygen-free days, and shorter length of stay. Studies are needed to validate our single-center study.
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