Journal
JOURNAL OF PAEDIATRICS AND CHILD HEALTH
Volume 55, Issue 6, Pages 632-639Publisher
WILEY
DOI: 10.1111/jpc.14260
Keywords
blood pressure; fluid; infant; newborn; therapy
Categories
Funding
- Australian Government Research Training Program Scholarship
- Royal Australasian College of Physicians Foundation
- Women's and Children's Hospital Foundation
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC)
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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.
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