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Department of Paediatrics, Prince of Wales
Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
Correspondence to: Dr TF Fok.
Accepted 11 October 1996
AIM
To compare the efficacy of a colloid (5%
albumin) and a crystalloid (isotonic saline) solution for treating
hypotension in mechanically ventilated preterm infants.
METHODSSixty three preterm infants weighing 540 to 1950 g at birth and with gestational ages of 23 to 34 weeks, who
developed hypotension (mean arterial pressure < 25, 30, and 35 mm Hg
for infants with birthweight <1, 1-1.49, and 1.5-1.99 kg,
respectively) within the first 2 hours of life, were randomly allocated
to receive intravenous infusions at 10 ml/kg of either 5% albumin
(group 1, n=32) or isotonic (0.9%) saline (group 2, n=31). Inotropic support with dopamine infusion was given if the infants remained hypotensive after a total of three infusions (30 ml/kg). Subsequent extra doses of volume expander in the form of 5% albumin was given, depending on the infant's blood pressure.
RESULTSThere was no difference in the volume of
the test solutions required between the two groups. Outcome, as
assessed by the number of infants requiring inotropic support and death
or chronic lung disease, did not differ between the groups. After
inotropic support, however, group 1 required significantly more volume
expander to maintain normal blood pressure (median: 27.5 ml/kg
vs 10 ml/kg; P=0.0187) and had a higher mean (SEM)
percentage weight gain within the first 48 hours of life (at 24 hours:
6.3(1.3)% vs 3.3(0.8)%; P=0.049; at 48 hours: 5.9(1.9)%
vs 0.9(1.7)%; P=0.045). The difference in weight gain was
significant at 48 hours even when only those infants not requiring
inotropic support or extra 5% albumin were compared (group 1:
1.5(1.5)%, group 2: -4.2(1.1)%; P = 0.027).
CONCLUSIONSIsotonic saline is as effective as 5%
albumin for treating hypotension in preterm infants, and it has the
additional advantage of causing less fluid retention in the first 48 hours.
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