International, multicentre, observational study of fluid bolus therapy in neonates
- 16 October 2018
- journal article
- research article
- Published by Wiley in Journal of Paediatrics and Child Health
- Vol. 55 (6), 632-639
- https://doi.org/10.1111/jpc.14260
Abstract
Aim To assess the prevalence, types and indications for fluid bolus therapy in neonates with haemodynamic compromise. Methods This was a pragmatic, international, multicentre observational study in neonatal units across Australasia, Europe and North America with a predefined study period of 10–15 study days per participating neonatal unit between December 2015 and March 2017. Infants ≤28 days of age who received a fluid bolus for the management of haemodynamic compromise (≥10 mL/kg given at ≤6 h) were included. Results A total of 163 neonates received a bolus over 8479 eligible patient days in 41 neonatal units. Prevalence of fluid bolus therapy varied between centres from 0 to 28.6% of admitted neonates per day, with a pooled prevalence rate of 1.5% (95% confidence interval 1.1–1.9%). The most common fluid used was 0.9% sodium chloride (129/163; 79%), and the volume of fluid administered was most commonly 10 mL/kg (115/163; 71%) over a median of 30 min (interquartile range 20–60). The most frequent indications were hypotension (n = 56; 34%), poor perfusion (n = 20; 12%) and metabolic acidosis (n = 20; 12%). Minimal or no clinical improvement was reported by clinicians in 66 of 163 cases (40%). Conclusions Wide international variations in types, indications and effects of fluid bolus administration in haemodynamically compromised neonates suggest uncertainty in the risk–benefit profile. This is likely to reflect the lack of robust evidence to support the efficacy of different fluid types, doses and appropriate indications. Together, these highlight a need for further clinically relevant studies.Keywords
Funding Information
- National Institute for Health Research
This publication has 23 references indexed in Scilit:
- Post transfusion lung injury in the neonatal populationJournal of Perinatology, 2012
- Transfusion Associated Necrotizing Enterocolitis: A Meta-analysis of Observational DataPublished by American Academy of Pediatrics (AAP) ,2012
- Mortality after Fluid Bolus in African Children with Severe InfectionNew England Journal of Medicine, 2011
- Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics supportJournal of Biomedical Informatics, 2008
- Is an intravenous fluid bolus of albumin or normal saline beneficial in the treatment of metabolic acidosis in a normovolaemic newborn?Archives of Disease in Childhood, 2004
- A randomized trial comparing the effect of prophylactic intravenous fresh frozen plasma, gelatin or glucose on early mortality and morbidity in preterm babiesEuropean Journal of Pediatrics, 1996
- Renal Function in Preterm Infants during the First Five Days of Life: Influence of Maturation and Early Colloid TreatmentNeonatology, 1992
- Prevention of intraventricular haemorrhage by fresh frozen plasma.Archives of Disease in Childhood, 1985
- The association of rapid volume expansion and intraventricular hemorrhage in the preterm infantThe Journal of Pediatrics, 1980
- The role of exchange transfusions in the management of low-birth-weight infants with and without severe respiratory distress syndromeThe Journal of Pediatrics, 1976