Decrease in the Use of Parenteral Fluids in Premature Infants from 31 to 34 Weeks of Gestation at Birth

Introduction: Some of the practices in medicine are carried out of habit without proven benefits. This is the case of premature babies from 31 to 34 weeks of gestation who are always given parenteral fluids, even though this practice has been associated with an increase incidence of infection. In 2017, we started a protocol of parenteral fluid restriction. To administer nutrition/fluids, we used oral fluids by suction if this was possible or otherwise by oral/nasogastric tube at volumes of 15-20 mL intake every 3 hours, with 5 mL increments every 12-24 hours until 200 mL/K/day was achieved, always using breast milk when possible.Material and methods: The present study sought to compare cases before and after this new policy. For this work, we review all premature babies between 31-34 weeks of gestation discharged home in two periods of time, the first from 01/01/2012 to 12/31/2017 and the second from 01/01/2018 to 08/31/2021. The number of cases with and without parenteral fluids (PF), the incidence of infection, the weight at admission and discharge, and the fall in the weight Z score between birth and discharge were compared. Both the anthropometric and outcome variables were compared using the different statistical methods according to each variable.Results: 725 cases were found with the described characteristics. The groups before and after the intervention did not show significant differences in their general demographic characteristics. A lower use of PF was observed in the second period from 348 cases (79%) to 70 (24%), p <0.001 and fewer days of use (4.1 days/case vs 1.3, p <0.0001) of PF. The weight at discharge and the change in weight Z-score were the same in both groups. Infections went from three cases to zero but it was not statistically significant. There were no complications due to less use of PF.Discussion: This study showed that the use of PF is not associated with significant changes in outcomes of interest, which reinforces that its use does not generate any benefit for the patient. Larger number of cases is required to detect differences in low incidence events such as infections.