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Benefits and risks of calcium resonium therapy in hyperkalaemic preterm infants
T Grammatikopoulos1, A Greenough, C Pallidis
1Department of Child Health, King's College Hospital, London, UK.
Insights
Rectal administration of calcium resonium resin in premature infants is not evidence-based and carries significant risks. Glucose and insulin infusions are more effective and safer alternatives for managing hyperkalemia in neonates.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Clinical Pharmacology
Background:
- Hyperkalemia is a critical concern in premature infants, often managed with medications like calcium resonium resin.
- The use of exchange resins in neonatal care lacks robust evidence, prompting a review of current practices.
Observation:
- An intestinal perforation occurred in a premature infant after rectal administration of calcium resonium resin.
- Literature review revealed anecdotal evidence supporting resin use but a lack of high-quality trials in preterm infants.
Findings:
- The only randomized trial in premature infants showed resins were less effective than glucose and insulin infusions for hyperkalemia.
- Reported side effects of resins include colonic necrosis, impaction, and perforation, particularly concerning in neonates.
Implications:
- The current evidence does not support the routine use of exchange resins in premature infants.
- Further randomized trials are needed to definitively assess the risks and benefits of exchange resins in this vulnerable population.
Unlabelled:
The occurrence of an intestinal perforation in a prematurely born infant following rectal administration of a calcium resonium resin prompted a literature review to determine whether use of resins in neonates was evidence based. This revealed that the results of anecdotal series suggested that resins were useful, but the only randomized trial including prematurely born infants demonstrated that resins were less efficacious than glucose and insulin infusions. Important side effects were reported including colonic necrosis and impaction with perforation.
Conclusion:
The risks and benefits of exchange resins in prematurely born infants should be assessed in an appropriately sized randomized trial.