Association between hemodynamically significant patent ductus arteriosus and fluid intake in the first week of life in a cohort of very low birth weight preterm infants: the COOL study.

The amount of fluid to give in preterm infants with patent ductus arteriosus (PDA) is still highly debated, with no robust evidence that fluid restriction provides a clear benefit. The aim of the study is to evaluate if spontaneous closure of PDA or development of hemodynamically significant PDA (hsPDA) is significantly correlated with the amount of fluid administered in the first week of life. Clinical charts of 126 very low birth weight infants with similar gestational age and birth weight were reviewed. Sixty-three patients experienced spontaneous closure of PDA, while 63 patients needed some kind of treatment for PDA. For each patient, daily fluid intake in the first week of life was collected. No statistically significant differences in total fluid intake (intravenous, oral, or both) were observed between the groups (p-value > 0.05). Additionally, no notable associations were found between intravenous intake (OR 1.00; CI 95% 0.99-1.01) or total intake (OR 1.00; CI 95% 0.99-1.01) and the incidence of treatment-requiring PDA.

conclusionFluid intake in the first week of life seems not to be significantly related to the need for pharmacological or surgical treatment of PDA in preterm infants. WHAT IS KNOWN: • Conservative management of PDA has gained increasing interest, as no clear benefit from treating PDA has been demonstrated. • Among conservative approaches, fluid restriction is often used to prevent and manage PDA, with inconclusive results. WHAT IS NEW: • Fluid intake during the first week of life doesn't seem to be associated with a higher risk of PDA requiring treatment.