Randomised controlled trial: comparison of colloid or crystalloid for partial exchange transfusion for treatment of neonatal polycythaemia
Department of Paediatrics Prince of Wales
Hospital Shatin Hong Kong People's
Republic of China
Correspondence to: Dr William Wong.
Accepted 18 March 1997
AIM
To compare the efficacy of using isotonic
saline (crystalloid) or 5% albumin (colloid) as replacement fluid in
partial exchange transfusion (PET) for the treatment of neonatal polycythaemia.
METHODSOne hundred and two polycythaemic full
term infants were randomly allocated to receive PET with either
isotonic saline or 5% albumin. The criteria for PET were: (a) venous
haematocrit 
0.7; or (b) venous haematocrit 0.65-0.69 with symptoms
or signs attributable to polycythaemia.
RESULTSPET with either saline (n=53) or 5%
albumin (n=50) resulted in a significant and sustained decline in
haematocrit up to 24 hours after PET. Although the immediate
haemodilution effect of isotonic saline was statistically smaller than
that of 5% albumin (decline in haematocrit 19.3% vs
22.8% of pre-PET value), the difference was too small to be of any
clinical significance, and the haematocrit at 4 or 24 hours after PET
did not differ significantly between the two groups. PET with either
replacement fluid was not associated with any complication. The serum
sodium and potassium concentrations were not significantly affected by
the PET in either group.
CONCLUSIONSBoth isotonic saline and 5% albumin
are effective when used as replacement fluid in PET for the treatment
of neonatal polycythaemia. Isotonic saline, which is cheaper and free
of infection, should be the replacement fluid of choice.
© 1997 by Archives of Disease in Childhood
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