{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T15:46:32Z","timestamp":1772034392657,"version":"3.50.1"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T00:00:00Z","timestamp":1618876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>Fluid overload (FO) in neonates is understudied, and its management requires nuanced care and an understanding of the complexity of neonatal fluid dynamics. Recent studies suggest neonates are susceptible to developing FO, and neonatal fluid balance is impacted by multiple factors including functional renal immaturity in the newborn period, physiologic postnatal diuresis and weight loss, and pathologies that require fluid administration. FO also has a deleterious impact on other organ systems, particularly the lung, and appears to impact survival. However, assessing fluid balance in the postnatal period can be challenging, particularly in extremely low birth weight infants (ELBWs), given the confounding role of maternal serum creatinine (Scr), physiologic weight changes, insensible losses that can be difficult to quantify, and difficulty in obtaining accurate intake and output measurements given mixed diaper output. Although significant FO may be an indication for kidney replacement therapy (KRT) in older children and adults, KRT may not be technically feasible in the smallest infants and much remains to be learned about optimal KRT utilization in neonates. This article, though not a meta-analysis or systematic review, presents a comprehensive review of the current evidence describing the effects of FO on outcomes in neonates and highlights areas where additional research is needed.<\/jats:p>","DOI":"10.3389\/fped.2021.651458","type":"journal-article","created":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T05:05:37Z","timestamp":1618895137000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Fluid Balance in the Critically Ill Child Section: \u201cHow Bad Is Fluid in Neonates?\u201d"],"prefix":"10.3389","volume":"9","author":[{"given":"Austin","family":"Rutledge","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heidi J.","family":"Murphy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew W.","family":"Harer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer G.","family":"Jetton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,4,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1038\/ki.2009.159","article-title":"Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury","volume":"76","author":"Bouchard","year":"2009","journal-title":"Kidney Int."},{"key":"B2","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1097\/PCC.0b013e31822882a3","article-title":"Fluid overload is associated with impaired oxygenation and morbidity in critically ill children","volume":"13","author":"Arikan","year":"2012","journal-title":"Pediatr Crit Care Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e001918","DOI":"10.1161\/jaha.115.001918","article-title":"Volume overload and adverse outcomes in chronic kidney disease: clinical observational and animal studies","volume":"4","author":"Hung","year":"2015","journal-title":"J Am Heart Assoc."},{"key":"B4","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1001\/jamapediatrics.2017.4540","article-title":"Association between fluid balance and outcomes in critically ill children: a systematic review and meta-analysis","volume":"172","author":"Alobaidi","year":"2018","journal-title":"JAMA Pediatr."},{"key":"B5","first-page":"1854","article-title":"Fluid, electrolytes, and acid-base homeostasis","volume-title":"Fanaroff and Martin's Neonatal-Perinatal Medicine","author":"Dell","year":"2020"},{"key":"B6","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1007\/s12098-008-0055-0","article-title":"Fluid and electrolyte management in term and preterm neonates","volume":"75","author":"Chawla","year":"2008","journal-title":"Indian J Pediatr."},{"key":"B7","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/s0140-6736(79)90135-1","article-title":"High-volume fluid intake predisposes premature infants to necrotising enterocolitis","volume":"2","author":"Bell","year":"1979","journal-title":"Lancet."},{"key":"B8","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1056\/nejm198003133021103","article-title":"Effect of fluid administration on the development of symptomatic patent ductus arteriosus and congestive heart failure in premature infants","volume":"302","author":"Bell","year":"1980","journal-title":"N Engl J Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1016\/s0022-3476(05)80658-4","article-title":"Hydration during the first days of life and the risk of bronchopulmonary dysplasia in low birth weight infants","volume":"116","author":"Van Marter","year":"1990","journal-title":"J Pediatr."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1345","DOI":"10.1542\/peds.104.6.1345","article-title":"Risk factors for chronic lung disease in the surfactant era: a North Carolina population-based study of very low birth weight infants","volume":"104","author":"Marshall","year":"1999","journal-title":"N C Neonatol Assoc Pediatr."},{"key":"B11","doi-asserted-by":"publisher","first-page":"11","DOI":"10.3233\/npm-190309","article-title":"A physiological approach to fluid and electrolyte management of the preterm infant: review","volume":"13","author":"Segar","year":"2020","journal-title":"J Neonatal Perinatal Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"Cd000503","DOI":"10.1002\/14651858.CD000503.pub3","article-title":"Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants","volume":"2014","author":"Bell","year":"2014","journal-title":"Cochrane Database Syst Rev."},{"key":"B13","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/j.jpeds.2011.06.027","article-title":"Randomized controlled trial of restrictive fluid management in transient tachypnea of the newborn","volume":"160","author":"Stroustrup","year":"2012","journal-title":"J Pediatr."},{"key":"B14","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1111\/chd.12165","article-title":"Is there a benefit to postoperative fluid restriction following infant surgery?","volume":"9","author":"Nicholson","year":"2014","journal-title":"Congenit Heart Dis."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1166","DOI":"10.1007\/s00134-011-2231-3","article-title":"Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy","volume":"37","author":"Selewski","year":"2011","journal-title":"Intensive Care Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1111\/j.1651-2227.2012.02591.x","article-title":"Reliability of the fluid balance in neonates","volume":"101","author":"van Asperen","year":"2012","journal-title":"Acta Paediatr."},{"key":"B17","doi-asserted-by":"publisher","first-page":"F149","DOI":"10.1152\/ajprenal.00439.2013","article-title":"Assessment of renal functional maturation and injury in preterm neonates during the first month of life","volume":"307","author":"Gubhaju","year":"2014","journal-title":"Am J Physiol Renal Physiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1007\/s00467-016-3539-6","article-title":"The role of fluid overload in the prediction of outcome in acute kidney injury","volume":"33","author":"Selewski","year":"2018","journal-title":"Pediatr Nephrol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1007\/s00467-012-2369-4","article-title":"Fluid overload and mortality are associated with acute kidney injury in sick near-term\/term neonate","volume":"28","author":"Askenazi","year":"2013","journal-title":"Pediatr Nephrol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"982","DOI":"10.1016\/s0022-3476(78)80382-5","article-title":"Bronchopulmonary dysplasia: possible relationship to pulmonary edema","volume":"92","author":"Brown","year":"1978","journal-title":"J Pediatr."},{"key":"B21","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1038\/sj.jp.7211895","article-title":"Fluid regimens in the first week of life may increase risk of patent ductus arteriosus in extremely low birth weight infants","volume":"28","author":"Stephens","year":"2008","journal-title":"J Perinatol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1097\/PCC.0b013e3182712799","article-title":"Fluid overload in infants following congenital heart surgery","volume":"14","author":"Hazle","year":"2013","journal-title":"Pediatr Crit Care Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1177\/2150135115586814","article-title":"Acute kidney injury and fluid overload in neonates following surgery for congenital heart disease","volume":"6","author":"Piggott","year":"2015","journal-title":"World J Pediatr Congenit Heart Surg."},{"key":"B24","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1097\/pcc.0000000000000715","article-title":"Fluid overload is associated with late poor outcomes in neonates following cardiac surgery","volume":"17","author":"Wilder","year":"2016","journal-title":"Pediatr Crit Care Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1007\/s00467-017-3818-x","article-title":"Fluid overload independent of acute kidney injury predicts poor outcomes in neonates following congenital heart surgery","volume":"33","author":"Mah","year":"2018","journal-title":"Pediatr Nephrol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1016\/s0022-3476(05)80746-2","article-title":"Multivariate assessment of traditional risk factors for chronic lung disease in very low birth weight neonates","volume":"119","author":"Palta","year":"1991","journal-title":"Newborn Lung Project J Pediatr."},{"key":"B27","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1016\/j.jpeds.2005.06.039","article-title":"Association between fluid intake and weight loss during the first ten days of life and risk of bronchopulmonary dysplasia in extremely low birth weight infants","volume":"147","author":"Oh","year":"2005","journal-title":"J Pediatr."},{"key":"B28","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1038\/sj.jp.7211751","article-title":"Association between early postnatal weight loss and death or BPD in small and appropriate for gestational age extremely low-birth-weight infants","volume":"27","author":"Wadhawan","year":"2007","journal-title":"J Perinatol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1665","DOI":"10.1007\/s00431-020-03654-z","article-title":"Early fluid overload is associated with mortality and prolonged mechanical ventilation in extremely low birth weight infants","volume":"179","author":"Matsushita","year":"2020","journal-title":"Eur J Pediatr."},{"key":"B30","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1038\/s41390-018-0183-9","article-title":"The impact of fluid balance on outcomes in critically ill near-term\/term neonates: a report from the AWAKEN study group","volume":"85","author":"Selewski","year":"2019","journal-title":"Pediatr Res."},{"key":"B31","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1038\/s41390-019-0579-1","article-title":"The impact of fluid balance on outcomes in premature neonates: a report from the AWAKEN study group","volume":"87","author":"Selewski","year":"2020","journal-title":"Pediatr Res."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1126","DOI":"10.1097\/pcc.0000000000001349","article-title":"The impact of fluid overload on outcomes in children treated with extracorporeal membrane oxygenation: a multicenter retrospective cohort study","volume":"18","author":"Selewski","year":"2017","journal-title":"Pediatr Crit Care Med."},{"key":"B33","doi-asserted-by":"publisher","first-page":"2694","DOI":"10.1097\/CCM.0b013e318258ff01","article-title":"Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy","volume":"40","author":"Selewski","year":"2012","journal-title":"Crit Care Med."},{"key":"B34","doi-asserted-by":"publisher","first-page":"2145","DOI":"10.1007\/s00467-016-3363-z","article-title":"Fluid overload and outcomes in neonates receiving continuous renal replacement therapy","volume":"31","author":"Lee","year":"2016","journal-title":"Pediatr Nephrol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1007\/s00467-019-04468-4","article-title":"Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy: a multicenter retrospective cohort study","volume":"35","author":"Gorga","year":"2020","journal-title":"Pediatr Nephrol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1053\/j.ajkd.2009.10.048","article-title":"Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry","volume":"55","author":"Sutherland","year":"2010","journal-title":"Am J Kidney Dis."},{"key":"B37","doi-asserted-by":"publisher","first-page":"e753","DOI":"10.1097\/ccm.0000000000003862","article-title":"Fluid overload associates with major adverse kidney events in critically ill patients with acute kidney injury requiring continuous renal replacement therapy","volume":"47","author":"Woodward","year":"2019","journal-title":"Crit Care Med."},{"key":"B38","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1161\/circheartfailure.109.856229","article-title":"Heart failure in children: part II: diagnosis, treatment, and future directions","volume":"2","author":"Hsu","year":"2009","journal-title":"Circ Heart Fail."},{"key":"B39","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1002\/ppul.1950030405","article-title":"Effect of early furosemide administration in neonates with respiratory distress syndrome","volume":"3","author":"Belik","year":"1987","journal-title":"Pediatr Pulmonol."},{"key":"B40","doi-asserted-by":"publisher","first-page":"Cd001454","DOI":"10.1002\/14651858.CD001454.pub3","article-title":"Diuretics for respiratory distress syndrome in preterm infants","volume":"2011","author":"Stewart","year":"2011","journal-title":"Cochrane Database Syst Rev."},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-021-04921-3","article-title":"Use of diuretics in the neonatal period","author":"Guignard","year":"2021","journal-title":"Pediatr Nephrol."},{"key":"B42","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1016\/s2352-4642(17)30069-x","article-title":"Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study","volume":"1","author":"Jetton","year":"2017","journal-title":"Lancet Child Adolesc Health."},{"key":"B43","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1016\/j.athoracsur.2019.03.066","article-title":"Peritoneal dialysis vs. diuretics in children after congenital heart surgery","volume":"108","author":"Flores","year":"2019","journal-title":"Ann Thorac Surg."},{"key":"B44","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1016\/j.jpeds.2012.08.044","article-title":"Continuous renal replacement therapy for children \u226410 kg: a report from the prospective pediatric continuous renal replacement therapy registry","volume":"162","author":"Askenazi","year":"2013","journal-title":"J Pediatr."},{"key":"B45","doi-asserted-by":"publisher","first-page":"1432","DOI":"10.2215\/cjn.03240319","article-title":"Kidney support in children using an ultrafiltration device: a multicenter, retrospective study","volume":"14","author":"Menon","year":"2019","journal-title":"Clin J Am Soc Nephrol."},{"key":"B46","doi-asserted-by":"publisher","first-page":"1699","DOI":"10.1007\/s00467-020-04562-y","article-title":"Continuous kidney replacement therapy in critically ill neonates and infants: a retrospective analysis of clinical results with a dedicated device","volume":"35","author":"Garzotto","year":"2020","journal-title":"Pediatr Nephrol."},{"key":"B47","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1016\/s0022-3476(77)80645-8","article-title":"Fluid administration in the association of patent ductus arteriosus complicating respiratory distress syndrome","volume":"90","author":"Stevenson","year":"1977","journal-title":"J Pediatr."},{"key":"B48","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1111\/j.1651-2227.1983.tb09868.x","article-title":"Edema formation in the lungs and its relationship to neonatal respiratory distress","volume":"305","author":"Bland","year":"1983","journal-title":"Acta Paediatr Scand Suppl."},{"key":"B49","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1016\/0022-3468(91)90665-g","article-title":"Pulmonary edema and fluid mobilization as determinants of the duration of ECMO support","volume":"26","author":"Kelly","year":"1991","journal-title":"J Pediatr Surg."}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2021.651458\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T05:05:40Z","timestamp":1618895140000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2021.651458\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,20]]},"references-count":49,"alternative-id":["10.3389\/fped.2021.651458"],"URL":"https:\/\/doi.org\/10.3389\/fped.2021.651458","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,20]]},"article-number":"651458"}}