Register for email alerts and news feeds:
This journal | BMJ Group
rss
Archives of Disease in Childhood - Fetal and Neonatal Edition 2000;83:F91-F96; doi:10.1136/fn.83.2.F91
Copyright © 2000 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health.
Arch Dis Child Fetal Neonatal Ed 2000;83:F91-F96 ( September )

Randomised trial of fluid restriction in ventilated very low birthweight infants

V Kavvadiaa, A Greenougha, G Dimitrioua, R Hooperb

a Children Nationwide Regional Neonatal Intensive Care Centre, King's College Hospital, London SE5 9RS, UK, b Department of Public Health, King's College Hospital

Correspondence to: Professor Greenough email: anne.greenough{at}kcl.ac.uk

Accepted 11 May 2000

BACKGROUND---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.


Key messages

  • High fluid volumes increase the likelihood of a PDA, a risk factor for CLD development
  • One of four previous randomised trials showed that fluid restriction improved outcome---that is, a lower mortality in a relatively mature population
  • We now show in ventilated VLBW infants that fluid restriction in the perinatal period does not reduce CLD; colloid infusion, however, increases duration of oxygen dependency




Keywords: chronic lung disease; prematurity; very low birthweight; fluid restriction; lungs; survival


© 2000 by Archives of Disease in Childhood

Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?

This Article

Services
Citing Articles
Google Scholar
PubMed
Topic Collections
Bookmark with

Register for free content

The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

Latest from ADC

 

ADC is co-owned by the RCPCH and is the official journal of the European Academy of Paediatrics

BMJ Careers - Latest Paediatrics and Paediatric Surgery Jobs

Paediatrics and Paediatric Surgery Jobs