Dextrose-containing intraoperative fluid in neonates: a randomized controlled trial.

Area of Science:

• Neonatalogy
• Pediatric Surgery
• Metabolic Research

Background:

• Optimal perioperative fluid management for neonates undergoing surgery is not well-defined.
• The impact of glucose supplementation on neonatal metabolism during surgical procedures requires further clarification.

Purpose of the Study:

• To determine an appropriate perioperative fluid regimen for neonates that effectively maintains carbohydrate and lipid homeostasis.
• To compare the metabolic and endocrine effects of different dextrose concentrations during neonatal surgery.

Main Methods:

• Forty-five neonates undergoing tracheo-esophageal fistula repair were randomized into three groups.
• Groups received varying dextrose concentrations (1%, 2%, or 10%) in intravenous fluids at different infusion rates.
• Perioperative glucose homeostasis, electrolyte balance, acid-base status, and metabolic parameters were analyzed.

Main Results:

• While all groups showed increased blood glucose post-surgery, Group D1 (1% dextrose) exhibited significantly higher glucose levels and hyperglycemia at 24 hours compared to Group D4 (10% dextrose).
• Group D1 also showed a significant decrease in base excess, bicarbonate, and lactate, indicating acidosis.
• Lower serum insulin and a higher glucagon:insulin ratio were observed in Group D1 post-surgery.

Conclusions:

• Infusing 1% dextrose-containing fluids at 10 ml·kg(-1)·h(-1) during neonatal surgery promotes catabolism, insulin resistance, rebound hyperglycemia, and acidosis.
• Fluids containing 2-4% dextrose are more appropriate than 1% dextrose for major neonatal surgeries requiring an average fluid infusion rate of 10 ml·kg(-1)·h(-1).