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Randomised trial of fluid restriction in ventilated very low birthweight infants
V Kavvadia1, A Greenough, G Dimitriou
1Children Nationwide Regional Neonatal Intensive Care Centre, King's College Hospital, London SE5 9RS, UK.
Insights
Fluid restriction did not reduce chronic lung disease (CLD) in ventilated premature infants. However, it did reduce the need for postnatal steroids, while colloid input increased oxygen dependency.
Area of Science:
- Neonatalogy
- Pediatric Pulmonology
- Critical Care Medicine
Background:
- Fluid restriction may improve survival in infants without chronic lung disease (CLD).
- Its effect on reducing CLD in high-risk infants receiving antenatal steroids and postnatal surfactant is unknown.
- Potential adverse outcomes of fluid restriction require investigation.
Purpose of the Study:
- To determine the impact of fluid restriction on outcomes in ventilated, very low birthweight infants.
- To assess if fluid restriction affects CLD incidence and other adverse events.
- To evaluate the association between fluid input and oxygen dependency.
Main Methods:
- A randomized trial comparing standard fluid volumes with approximately 80% of standard input in 168 ventilated infants.
- Infants had a median gestational age of 27 weeks.
- Outcomes assessed included CLD, survival without oxygen dependency, and acute renal failure.
Main Results:
- No significant differences in CLD rates at 28 days or 36 weeks post conceptional age between fluid restriction and standard groups.
- Similar survival rates without oxygen dependency at both time points.
- Fewer infants in the restricted group received postnatal steroids (19% vs. 43%, p < 0.01).
- Colloid input, not crystalloid, was significantly associated with increased duration of oxygen dependency.
Conclusions:
- Fluid restriction in the perinatal period does not reduce CLD in ventilated, very low birthweight infants.
- Fluid restriction does not increase other adverse outcomes.
- Colloid infusion is linked to a longer duration of oxygen dependency.
Background:
Fluid restriction has been reported to improve survival of infants without chronic lung disease (CLD), but it remains unknown whether it reduces CLD in a population at high risk of CLD routinely exposed to antenatal steroids and postnatal surfactant without increasing other adverse outcomes.
Aim:
To investigate the impact of fluid restriction on the outcome of ventilated, very low birthweight infants.
Study Design:
A randomised trial of two fluid input levels in the perinatal period was performed. A total of 168 ventilated infants (median gestational age 27 weeks (range 23-33)) were randomly assigned to receive standard volumes of fluid (60 ml/kg on day 1 progressing to 150 ml/kg on day 7) or be restricted to about 80% of standard input.
Results:
Similar proportions of infants on the two regimens had CLD beyond 28 days (56% v 51%) and 36 weeks post conceptional age (26% v 25%), survived without oxygen dependency at 28 days (31% v 27%) and 36 weeks post conceptional age (58% v 52%), and developed acute renal failure. There were no statistically significant differences between other outcomes, except that fewer of the restricted group (19% v 43%) required postnatal steroids (p < 0.01). In the trial population overall, duration of oxygen dependency related significantly to the colloid (p < 0.01), but not crystalloid, input level; after adjustment for specified covariates, the hazard ratio was 1.07 (95% confidence interval 1.02 to 1.13).
Conclusions:
In ventilated, very low birthweight infants, fluid restriction in the perinatal period neither reduces CLD nor increases other adverse outcomes. Colloid infusion, however, is associated with increased duration of oxygen dependency.