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Research Snapshot Theater: Research, Pediatric II

Divergence Between Net Fluid and Weight Measures in Calculating Cumulative Fluid Balance

Sunday, March 22, 2026
11:00 AM - 12:00 PM Central Time
Location: Connections Central - RST 18

  • Finley J. Shinnick, n/a

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • DH

    Denise C. Hasson, MD

    Assistant Professor, Department of Pediatrics
    NYU Langone Medical Center and School of Medicine

    Disclosure information not submitted.

  • UK

    Ulka Kothari, MD

    Associate Professor, Department of Pediatrics
    New York University Grossman Long Island School of Medicine

    Disclosure information not submitted.

  • AS

    Ami Shah, MD

    Clinical Assistant Professor, Department of Pediatrics
    NYU Langone Medical Center and School of Medicine

    Disclosure information not submitted.

  • JO

    James D. Odum, MD

    Assistant Professor, Associate Director of Pediatric and Infant Center for Acute Nephrology
    Children's of Alabama

    Disclosure information not submitted.

  • CB

    Chloe G. Braun, MD

    Assistant Professor
    University of Louisville School of Medicine

    Disclosure information not submitted.

  • CD

    Celeste G. Dixon, MD

    Attending Physician, Pediatric Critical Care Medicine
    Children's Hospital of Philadelphia

    Disclosure information not submitted.

  • JF

    Julie C. Fitzgerald, MD, PhD, MSCE, FCCM

    The Children's Hospital of Philadelphia, Pennsylvania

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • SM

    Susan D. Martin, MD

    Associate Professor, Department of Pediatric, Critical Care
    Golisano Children's Hospital University of Rochester

    Disclosure information not submitted.

  • NT

    Nina Terry, RN

    Registered Nurse
    Golisano Children's Hospital University of Rochester

    Disclosure information not submitted.

  • Adam C. Dziorny, MD, PhD

    Golisano Children's Hospital University of Rochester, New York

    Disclosure(s): No relevant financial relationship(s) to disclose.

Introduction: Excess cumulative fluid balance (CFB) is associated with morbidity in critically ill children. CFB, expressed as a percentage of body weight, is assessed by serial weight changes (CFBw) or by net fluid intake and output relative to ICU admission weight (CFBf). In this multicenter study, we compare CFBw and CFBf and stratify by patient characteristics. We hypothesize there will be a significant difference between CFB methods, and fewer unmeasured output occurrences will improve agreement.


Methods: We extracted electronic health record data from 4 PICUs and 2 CICUs for the first 7 days of admission. We described counts of repeated weight measurements (e.g. daily weights) and calculated CFBw as the change in weight divided by ICU admission weight. For each weight measure beyond admission weight, we calculated net fluid intake-output up to that time point and subsequently calculated CFBf as intake minus output divided by ICU admission weight. We assessed mean differences with Bland-Altman analyses and used linear models to evaluate differences in weight and occurrence frequency across units. We used Wilcox tests to assess differences between groups. Additional patient subgroups included patients with weights recorded on ICU day 0 (Early) and patients younger than one month (Neonate).


Results: Among 12,388 ICU encounters, there was a significant difference in the number of repeated weight measurements between sites (p < 0.001). Neonates had the highest rate of repeated weights. All sites and subgroups had positive bias between CFBf and CFBw (mean bias across sites: All patients = 4.7%, Early = 4.7%, Neonates = 5.9%), suggesting CFBf is greater, on average, than CFBw. Excluding values after a patient's first output occurrence slightly decreased bias between CFBf and CFBw (mean decrease: All Patients = -0.6%, Early = -1.2%, Neonates = -0.7%). Additionally, mean bias significantly increased over ICU admission (mean bias: days 0-3= 2.7%, days 4-7= 8.1%, p=0.002), and this difference increased for patients with early weights and neonates.


Conclusions: CFB by net fluid calculation is consistently higher than by weight, and this mean difference increases throughout ICU duration. Early weight measures may amplify these differences.