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Randomised trial of fluid restriction in ventilated very low birthweight infants.

AbstractBACKGROUND:
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.
AuthorsV Kavvadia, A Greenough, G Dimitriou, R Hooper
JournalArchives of disease in childhood. Fetal and neonatal edition (Arch Dis Child Fetal Neonatal Ed) Vol. 83 Issue 2 Pg. F91-6 (Sep 2000) ISSN: 1359-2998 [Print] England
PMID10952699 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Colloids
  • Glucocorticoids
Topics
  • Acute Kidney Injury (etiology)
  • Chronic Disease
  • Colloids
  • Disease-Free Survival
  • Female
  • Fluid Therapy (adverse effects, methods)
  • Glucocorticoids (therapeutic use)
  • Humans
  • Infant, Newborn
  • Infant, Very Low Birth Weight
  • Lung Diseases (etiology, therapy)
  • Male
  • Respiration, Artificial (methods)
  • Treatment Outcome

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