{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:27:23Z","timestamp":1760059643182,"version":"build-2065373602"},"reference-count":39,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CoMotion Innovation Gap Fund at the University of Washington","award":["K23HD105929"],"award-info":[{"award-number":["K23HD105929"]}]},{"name":"NIH","award":["K23HD105929"],"award-info":[{"award-number":["K23HD105929"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objective: We sought to address ongoing gaps in understanding the relationship between first-week percent maximal weight loss (MWL) and average first-week total fluid intake (TFI), enteral intake, and parenteral intake among premature newborns with adverse in-hospital outcomes born in low- and middle-income countries (LMICs). Methods: We evaluated newborns born &lt;34 weeks gestation or &lt;1500 g who survived at least 7 days at the St. Paul\u2019s Hospital Millennium Medical College (SPHMMC) neonatal intensive care unit in Ethiopia. We performed univariate and multivariate regression models analyzing the first-week MWL, average TFI, parenteral, and enteral intake and their relationships with adverse in-hospital outcomes. Results: Among N = 490 moderately and very preterm newborns, multivariate regression models demonstrated that &gt;13% MWL was associated with significantly increased odds of suspected necrotizing enterocolitis (NEC), culture-positive sepsis, retinopathy of prematurity (ROP), and a longer length of stay (LOS). An average enteral intake of &gt;60 mL\/kg\/day was significantly associated with reduced odds of all-cause mortality, suspected NEC, culture-positive sepsis, ROP, and a shorter LOS, whereas an average parenteral intake of &gt;60 mL\/kg\/day was associated with increased odds of in-hospital mortality, culture-positive sepsis, ROP, and a longer LOS. Conclusions: In moderately and very preterm neonates in an LMIC setting, &gt;13% MWL is associated with adverse health outcomes. Increasing the average parenteral intake over the first week after birth among moderately and very preterm neonates is significantly associated with adverse in-hospital outcomes whereas increasing the average enteral intake is associated with improved outcomes.<\/jats:p>","DOI":"10.3390\/children12070872","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T06:46:12Z","timestamp":1751438772000},"page":"872","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of First-Week Fluid Intake and Maximal Weight Loss Percentage with In-Hospital Adverse Outcomes Among Moderately and Very Preterm Newborns in Ethiopia"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3055-2987","authenticated-orcid":false,"given":"Gregory C.","family":"Valentine","sequence":"first","affiliation":[{"name":"Division of Neonatology, University of Washington, Seattle Children\u2019s Hospital, Seattle, WA 98195, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tessa","family":"Rue","sequence":"additional","affiliation":[{"name":"Division of Neonatology, University of Washington, Seattle Children\u2019s Hospital, Seattle, WA 98195, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0752-9509","authenticated-orcid":false,"given":"Olivia C.","family":"Brandon","sequence":"additional","affiliation":[{"name":"Division of Neonatology, University of Washington, Seattle Children\u2019s Hospital, Seattle, WA 98195, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5456-6059","authenticated-orcid":false,"given":"Krystle M.","family":"Perez","sequence":"additional","affiliation":[{"name":"Division of Neonatology, University of Washington, Seattle Children\u2019s Hospital, Seattle, WA 98195, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1130-2720","authenticated-orcid":false,"given":"Thomas R.","family":"Wood","sequence":"additional","affiliation":[{"name":"Division of Neonatology, University of Washington, Seattle Children\u2019s Hospital, Seattle, WA 98195, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8577-478X","authenticated-orcid":false,"given":"Sharla","family":"Rent","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Duke University, Durham, NC 27708, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gal","family":"Barbut","sequence":"additional","affiliation":[{"name":"Division of Neonatology, University of Rochester, Rochester, NY 14627, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Merhawit","family":"Abadi","sequence":"additional","affiliation":[{"name":"Division of Neonatology, St. Paul\u2019s Hospital Millennium Medical College, Addis Ababa 1165, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Redeat","family":"Workneh","sequence":"additional","affiliation":[{"name":"Division of Neonatology, St. Paul\u2019s Hospital Millennium Medical College, Addis Ababa 1165, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gesit","family":"Metaferia","sequence":"additional","affiliation":[{"name":"Division of Neonatology, St. Paul\u2019s Hospital Millennium Medical College, Addis Ababa 1165, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahlet","family":"Abayneh","sequence":"additional","affiliation":[{"name":"Division of Neonatology, St. Paul\u2019s Hospital Millennium Medical College, Addis Ababa 1165, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1016\/S0140-6736(23)00878-4","article-title":"National, regional, and global estimates of preterm birth in 2020, with trends from 2010: A systematic analysis","volume":"402","author":"Ohuma","year":"2023","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"04031","DOI":"10.7189\/jogh.13.04031","article-title":"Stillbirths and neonatal mortality in LMICs: A community-based mother-infant cohort study","volume":"13","author":"Rambliere","year":"2023","journal-title":"J. Glob. Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1056\/NEJMoa1403489","article-title":"Causes and timing of death in extremely premature infants from 2000 through 2011","volume":"372","author":"Patel","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.pedneo.2021.01.004","article-title":"Early inadequate or excessive weight loss: A potential contributor to mortality in premature newborns in resource-scarce settings?","volume":"62","author":"Valentine","year":"2021","journal-title":"Pediatr. Neonatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e000724","DOI":"10.1136\/bmjpo-2020-000724","article-title":"Evidence that informs feeding practices in very low birthweight and very preterm infants in sub-Saharan Africa: An overview of systematic reviews","volume":"4","author":"Akindolire","year":"2020","journal-title":"BMJ Paediatr. Open"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Imam, Z.O., Nabwera, H.M., Tongo, O.O., Andang\u2019o, P.E.A., Abdulkadir, I., Ezeaka, C.V., Ezenwa, B.N., Fajolu, I.B., Mwangome, M.K., and Umoru, D.D. (2024). Time to full enteral feeds in hospitalised preterm and very low birth weight infants in Nigeria and Kenya. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0277847"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1159\/000496015","article-title":"Early Total Enteral Feeding versus Conventional Enteral Feeding in Stable Very-Low-Birth-Weight Infants: A Randomised Controlled Trial","volume":"115","author":"Nangia","year":"2019","journal-title":"Neonatology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e002727","DOI":"10.1136\/bmjpo-2024-002727","article-title":"Human milk and bronchopulmonary dysplasia have a dose-dependent effect: A cohort study","volume":"9","author":"Yang","year":"2025","journal-title":"BMJ Paediatr. Open"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.clp.2023.04.002","article-title":"Early Fluid and Nutritional Management of Extremely Preterm Newborns During the Fetal-To-Neonatal Transition","volume":"50","author":"Valentine","year":"2023","journal-title":"Clin. Perinatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1038\/s41372-022-01369-7","article-title":"Postnatal maximal weight loss, fluid administration, and outcomes in extremely preterm newborns","volume":"42","author":"Valentine","year":"2022","journal-title":"J. Perinatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e2022057092E","DOI":"10.1542\/peds.2022-057092E","article-title":"Early Enteral Feeding for Preterm or Low Birth Weight Infants: A Systematic Review and Meta-analysis","volume":"150","author":"Chitale","year":"2022","journal-title":"Pediatrics"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1038\/s41390-024-03208-1","article-title":"Nutritional interventions to prevent retinopathy of prematurity","volume":"96","author":"Hellstrom","year":"2024","journal-title":"Pediatr. Res."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Wang, M., Gong, X., Yu, L., Song, F., Li, D., Fan, Q., Zhang, T., and Yan, X. (2024). Early enteral nutrition with exclusive donor milk instead of formula milk affects the time of full enteral feeding for very low birth weight infants. Front. Nutr., 11.","DOI":"10.3389\/fnut.2024.1345768"},{"key":"ref_14","doi-asserted-by":"crossref","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":"ref_15","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1038\/s41390-021-01485-8","article-title":"Fluid status in the first 10 days of life and death\/bronchopulmonary dysplasia among preterm infants","volume":"90","author":"Soullane","year":"2021","journal-title":"Pediatr. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"151927","DOI":"10.1016\/j.semperi.2024.151927","article-title":"Nutrition and the gut-brain axis in neonatal brain injury and development","volume":"48","author":"Perez","year":"2024","journal-title":"Semin. Perinatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1038\/s41372-024-01869-8","article-title":"Time to regain birthweight and association with neurodevelopmental outcomes among extremely preterm newborns","volume":"44","author":"Valentine","year":"2024","journal-title":"J. Perinatol."},{"key":"ref_18","unstructured":"Team, R.C. (2025, June 01). R: A Language and Environment for Statistical Computing. Available online: https:\/\/www.R-project.org\/."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"246","DOI":"10.21037\/tp.2019.07.03","article-title":"Economic assessment of neonatal intensive care","volume":"8","author":"Cheah","year":"2019","journal-title":"Transl. Pediatr."},{"key":"ref_20","unstructured":"WHO, UNICEF, UNFPA, and PMNCH (2023). Born Too Soon: Decade of Action on Preterm Birth."},{"key":"ref_21","unstructured":"Estimation UI-aGfCM (2023). Levels & Trends in Child Mortality: Report 2022, Estimates Developed by the United Nations Inter-Agency Group for Child Mortality Estimation, UN Children\u2019s Fund."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2162","DOI":"10.1016\/S0140-6736(12)60820-4","article-title":"National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: A systematic analysis and implications","volume":"379","author":"Blencowe","year":"2012","journal-title":"Lancet"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"102840","DOI":"10.1016\/j.eclinm.2024.102840","article-title":"Global, regional, and national burden of preterm birth, 1990-2021: A systematic analysis from the global burden of disease study 2021","volume":"76","author":"Liang","year":"2024","journal-title":"EClinicalMedicine"},{"key":"ref_24","doi-asserted-by":"crossref","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":"ref_25","doi-asserted-by":"crossref","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":"ref_26","first-page":"CD000503","article-title":"Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants","volume":"12","author":"Bell","year":"2014","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"306","DOI":"10.5005\/jp-journals-11002-0038","article-title":"Advancement of enteral feeding in very-low-birth-weight infants: Global issues and challenges","volume":"1","author":"Perez","year":"2022","journal-title":"Newborn"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1093\/ajcn\/nqy012","article-title":"Early progressive feeding in extremely preterm infants: A randomized trial","volume":"107","author":"Salas","year":"2018","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1136\/archdischild-2023-325969","article-title":"Early and exclusive enteral nutrition in infants born very preterm","volume":"109","author":"Razzaghy","year":"2024","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_30","first-page":"CD013542","article-title":"Early full enteral feeding for preterm or low birth weight infants","volume":"12","author":"Walsh","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1542\/neo.23-10-e738","article-title":"Updates in Late-Onset Sepsis: Risk Assessment, Therapy, and Outcomes","volume":"23","author":"Coggins","year":"2022","journal-title":"Neoreviews"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/S1473-3099(15)00409-0","article-title":"Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: A systematic review and meta-analysis","volume":"16","author":"Ista","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1038\/s41390-021-01533-3","article-title":"In neonatal sepsis every catheter matters","volume":"90","author":"Ohlin","year":"2021","journal-title":"Pediatr. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1016\/S0378-3782(14)70002-7","article-title":"Healthcare-associated infections in the hospitalized neonate: A review","volume":"90","author":"Hooven","year":"2014","journal-title":"Early Hum. Dev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e2022058813","DOI":"10.1542\/peds.2022-058813","article-title":"Late-Onset Sepsis Among Very Preterm Infants","volume":"150","author":"Flannery","year":"2022","journal-title":"Pediatrics"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"de Sousa, J.C.S., de Carvalho, A.V.D., Monte de Prada, L.C., Marinho, A.P., de Lima, K.F., Macedo, S.K.O., Santos, C.D.P., da Camara, S.M.A., Barreto, A., and Pereira, S.A. (2021). Nutritional Factors Associated with Late-Onset Sepsis in Very Low Birth Weight Newborns. Nutrients, 14.","DOI":"10.3390\/nu14010196"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"6962","DOI":"10.4081\/pr.2017.6962","article-title":"Postnatal Transitional Weight Loss and Adverse Outcomes in Extremely Premature Neonates","volume":"9","author":"Verma","year":"2017","journal-title":"Pediatr. Rep."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1111\/j.1651-2227.1998.tb00928.x","article-title":"Transepidermal water loss in infants born at 24 and 25 weeks of gestation","volume":"87","author":"Agren","year":"1998","journal-title":"Acta Paediatr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"151541","DOI":"10.1016\/j.semperi.2021.151541","article-title":"Fluid management considerations in extremely preterm infants born at 22\u201324 weeks of gestation","volume":"46","author":"Agren","year":"2022","journal-title":"Semin. Perinatol."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/7\/872\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:02:16Z","timestamp":1760032936000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/7\/872"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,1]]},"references-count":39,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["children12070872"],"URL":"https:\/\/doi.org\/10.3390\/children12070872","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2025,7,1]]}}}