Fluid Restriction Fails to Improve PDA Outcomes, Hampers Growth in Preterm Infants: Study Shows
Italy: A new study published in Pediatric Research has questioned the long-standing practice of fluid restriction in preterm infants undergoing pharmacological treatment for hemodynamically significant patent ductus arteriosus (hsPDA).
The research, led by Angela Paladini and colleagues from the Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, Rome, Italy, found that limiting fluids did not improve PDA closure rates but adversely affected growth and recovery outcomes in preterm babies.
The single-center retrospective cohort study compared two groups of preterm neonates who received drug treatment for hsPDA. The earlier cohort (2018–2020) was managed under a fluid-restricted regimen, with intake tailored according to gestational age and day of life—starting at about 70 ml/kg/day for extremely preterm infants (≤26 weeks). The more recent cohort (2021–2023) followed an updated protocol based on neonatal weight and day of life, allowing higher fluid intake (up to 100 ml/kg/day for infants under 1000 g on day 1).
The study led to the following findings:
- No significant difference was observed between standard and restricted fluid groups in PDA closure rates.
- Major neonatal complications, including intraventricular hemorrhage, necrotizing enterocolitis, and chronic lung disease, were similar in both groups.
- Infants on restricted fluids took longer to achieve full enteral feeding.
- Those under fluid restriction required central venous catheters for a longer duration.
- Fluid-restricted infants had lower weight and poorer growth outcomes at discharge.
According to the authors, these findings suggest that restricting fluids during pharmacological PDA treatment may not provide any clinical advantage but could instead hinder neonatal growth and prolong hospital care. The study highlights the need for a more balanced and individualized approach to fluid management, particularly for preterm infants who are highly sensitive to hydration changes.
Dr. Paladini and colleagues emphasized that while fluid restriction has been traditionally considered beneficial in promoting ductal closure, this study shows no such advantage. Instead, the practice might negatively impact early growth, potentially affecting long-term developmental outcomes. They suggest that clinicians should reconsider rigid fluid-limiting strategies and instead focus on optimizing hydration to support both cardiac and overall neonatal health.
The authors acknowledged certain limitations in their work, including the single-center design and the relatively small sample size, which may limit the generalizability of the findings. They also noted that the study compared a recent cohort with a retrospective one, reflecting evolving clinical practices rather than a randomized trial. Moreover, long-term neurodevelopmental outcomes were not assessed and warrant investigation in future studies.
The study highlights that fluid restriction during pharmacological treatment of hsPDA offers no improvement in ductal closure and may instead delay feeding progression, extend catheter use, and impede growth. The findings advocate against routine fluid restriction in this vulnerable group, encouraging further clinical research to refine fluid management strategies that best support preterm infants’ growth and recovery.
Reference:
Paladini, A., Bottoni, A., Prontera, G., Purcaro, V., Cantone, G. V., & Vento, G. (2025). Standard versus restricted fluid administration in preterm infants undergoing pharmacological treatment for haemodynamically significant patent ductus arteriosus. Pediatric Research, 1-7. https://doi.org/10.1038/s41390-025-04497-w
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