The use of volume expansion in preterm infants

There is no consensus of opinion regarding the appropriate use of volume expansion in the sick preterm infant. Recent evidence suggests that excessive volume expansion may increase mortality in this group. We determined the use of volume expansion in non-surgical preterm infants (<30 weeks gestation) among neonatal consultants in the West Midlands. A questionnaire was sent to 40 consultants working in all 16 neonatal units in the West Midlands region and re-sent one year later after presentation of interim regional mortality data. Responses were received from 15 units in 2000 and all 16 in 2001. Written guidelines for volume expansion were available in only 6 units (38%) in 2000 compared with 15 (94%) in 2001. The maximum volume expansion considered appropriate in the first 36 h of life reduced from a mean 37 mL/kg (range 15-150 mL/kg) in 2000 to 24 mL/kg (range 10-60 mL/kg) in 2001. In 2000 64% limited volume expansion to < or = 30 mL/kg (compared with 94% in 2001). Following regional discussion of interim mortality data and the subsequent development of unit guidelines, the prescription of volume expansion in the West Midlands region changed, with a reduction in the mean volume considered appropriate and greater consistency between units. The impact on neonatal outcome needs to be determined.