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.
AIMTo investigate the
impact of fluid restriction on the outcome of ventilated, very low
birthweight infants.
STUDY DESIGNA
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.
RESULTSSimilar
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).
CONCLUSIONSIn
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.
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Key messages
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Keywords: chronic lung disease; prematurity; very low birthweight; fluid restriction; lungs; survival
© 2000 by Archives of Disease in Childhood
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