{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T18:31:50Z","timestamp":1793125910304,"version":"4.5.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T00:00:00Z","timestamp":1752192000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T00:00:00Z","timestamp":1752192000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Res"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fluid overload in critically ill neonates and infants is associated with higher ventilation days, prolonged length of stay, and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This quality improvement study enrolled infants admitted to Children\u2019s 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 &gt;10%, hypotension, and major surgeries. The primary hypothesis was that the unit-wide ventilator-free days would increase after bundle implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We 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%);\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Oxygen-free days and NICU length of stay showed similar findings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Implementation 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Fluid overload leads to poor clinical outcomes, including the need for ventilatory support.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>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.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>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.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>We showed an increase in the number of ventilator-free days, oxygen-free days, and shorter length of stay.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Studies are needed to validate our single-center study.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41390-025-04078-x","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T17:00:00Z","timestamp":1752253200000},"page":"889-897","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Reducing NICU ventilator days by preventing fluid overload with the CAN-U-P-LOTS standardized bundle"],"prefix":"10.1038","volume":"99","author":[{"given":"David J.","family":"Askenazi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey","family":"Gordon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell","family":"Griffin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Collins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Black","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Namasivayam","family":"Ambalavanan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tennille","family":"Webb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meggie","family":"Mathis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kara","family":"Short","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyssa","family":"Umberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colm","family":"Travers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"key":"4078_CR1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.29442","volume":"5","author":"SL Goldstein","year":"2022","unstructured":"Goldstein, S. 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He has financial interests in patents\/innovations in urine collection devices. He is the Founder and Chief Scientific Officer for Zorro-Flow Inc.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}