Comparison of the effect of two fluid input regimens on perinatal lung function in ventilated infants of very low birthweight

Kavvadia, V; Greenough, Anne; Dimitriou, Gabriel; Hooper, Richard

doi:10.1007/s004310051242

Cited by 17 publications

(10 citation statements)

References 26 publications

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“…We found only few studies (Bauer et al, 1996;Wlodek et al, 1998;Baines et al, 2000;Kavvadia et al, 1999), which in conclusion could not demonstrate an unequivocal effect of different fluid regimens on perinatal ventilation in prematures. Figure 3 shows a schematic representation of the mucociliary apparatus, which in the lower airways of mammals, extends from the larynx to terminal bronchioles.…”

Section: )mentioning

confidence: 72%

Mild dehydration: a risk factor of broncho-pulmonary disorders?

Kalhoff¹

2003

Eur J Clin Nutr

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Several expert committees recommend a high fluid intake in patients with chronic bronchitis and asthma. Is there a relationship between fluid intake or hydration status and broncho-pulmonary disorders like bronchitis and asthma? First, basic physiologic mechanisms like regulation of lung fluid balance and water transport at pulmonary surfaces were analyzed, in order to characterize the role of local hydration status in lung and airways. Second, making use of the computerbased literature searches (PubMed), evidence for a role of hydration status in complex physiological and pathophysiological conditions of lungs and airways like perinatal lung adaptation (PLA) (in prematures), mucociliary clearance(MC) and asthma was categorized. The movement of fluid between the airspaces, interstitium, and vascular compartments in the lungs plays an important physiological role in the maintenance of hydration and protection of the lung epithelium and significantly contributes to a proper airway clearance. PLA is characterized by a rapid change from fluid secretion to fluid absorption in the distal respiratory tract, with the literature data confirming a critical role of the epithelial sodium channel. Only few studies have investigated the effect of different fluid input regimens on PLA in prematures. MC relies on the interaction between epithelial water fluxes, mucus secretions, and ciliary activity. Whereas animal data show that drying of the airway epithelium decreases MC, few clinical studies investigating the effect of local or systemic hydration on MC have led to ambiguous results. Asthma (A) is characterized by chronic airway inflammation and episodic airway obstruction. Data in animals and humans indicate an association between exercise-induced-A and conditioning (humidity and heat exchange) of inspired air. However, epidemiological studies (children and adults), investigating the role of fluid (and salt) input in the etiology of the disease as well as studies analyzing different markers of hydration status during asthmatic attacks have so far led to conflicting results. Some expert groups recommend sufficient hydration as a complementary A-therapy. Analysis of basic physiological mechanisms in lungs and airways clearly demonstrates a critical role for water transport and local hydration status. In broncho-pulmonary diseases, however, analysis of the complex pathophysiological mechanisms is difficult. Thus, we still need more studies to confirm or refute mild dehydration or hypohydration as a risk factor of broncho-pulmonary disorders.

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Section: )mentioning

confidence: 72%

Mild dehydration: a risk factor of broncho-pulmonary disorders?

Kalhoff¹

2003

Eur J Clin Nutr

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“…We, however, had tight eligibility criteria for results from infants in those studies to be included in this analysis and used the data from consecutively eligible infants. In only one of the studies [11] was there a randomised intervention, fluid restriction, but it was only applied in the first week after birth [12] and analysis of the perinatal lung function results [11] and clinical outcomes [12] revealed no statistically significant differences between the two groups. In the second study [4], the effect of posture on lung function was examined; in this study all of the infants were examined in the supine position.…”

Section: Discussionmentioning

confidence: 98%

“…None of the infants had respiratory symptoms at the time of the study or were receiving treatment with either bronchodilators or inhaled/systemic corticosteroids. The lung volume measurements had been as part of the protocol of two previous studies [1,11] and an on-going study prospectively examining lung function in prematurely born infants. Results from consecutive infants fulfilling the eligibility criteria for this study, that is, either having mild to moderate BPD or no BPD were analysed.…”

Section: Methodsmentioning

confidence: 99%

Lung volumes in infants who had mild to moderate bronchopulmonary dysplasia

et al. 2005

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"New" bronchopulmonary dysplasia (BPD) has been suggested to be a maldevelopment sequence with reduced alveolarisation of the lungs; affected infants then would be predicted to have low lung volumes. The aim of this study was to test that hypothesis by comparing the lung volumes of infants who had had mild-moderate BPD with those without BPD of similar postmenstrual age. Lung volumes of 17 infants who had mild-moderate BPD (oxygen dependent beyond 28 days, but not past term) (BPD infants) were compared to those of 17 infants without BPD (non-BPD infants). All were born at less than 33 weeks of gestation and studied at postmenstrual ages of 33 to 39 weeks. Lung volume was assessed by measurement of functional residual capacity (FRC). The BPD infants had lower lung volumes (median 19.1 ml/kg) than the non-BPD infants (median 26.5 ml/kg) (p = 0.0001). The BPD compared to the non-BPD infants were of greater postnatal age (p = 0.0003), born at a lower gestational age (p = 0.0001) and of lighter birthweight (p = 0.0001). Regression analysis, however, demonstrated that lung volume was significantly related to BPD status (p = 0.005), independently of postnatal age, birthweight and gestational age. It is concluded that the lower lung volumes of the infants who had had mild-moderate BPD support the hypothesis that new BPD is associated with poor alveolarisation.

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“…1,9,[28][29][30] These trials were summarized in a Cochrane review in 2001. 31 Three of these studies found no difference in rates of PDA or BPD in infants randomized to receive high or low fluid intakes.…”

Section: Discussionmentioning

confidence: 99%

Fluid regimens in the first week of life may increase risk of patent ductus arteriosus in extremely low birth weight infants

et al. 2007

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Background: High fluid volumes may increase neonatal morbidity. However, evidence supporting fluid restriction is inconclusive and restricting fluids may restrict caloric intake.Objective: To determine if higher fluid intake was associated with increased risk of patent ductus arteriosus (PDA) or bronchopulmonary dysplasia (BPD) in extremely low birth weight (ELBW) infants.Study Design: A total of 204 ELBW (p32 weeks, p1250 g) infant survivors were grouped into low-, intermediate-and high-fluid groups. w 2 analyzed proportions of subjects with and without morbidities across groups. Logistic regression quantified increased risk of PDA or BPD associated with fluid intake while controlling for confounders. Analysis of variance compared differences in caloric intake across groups.Result: After controlling for gestational age, severity of illness and weight change, fluid intake on day 2 (odds ratio (OR) 1.014; confidence interval (CI) 1.001 to 1.028) and day 3 (OR 1.022; CI 1.004 to 1.040) was associated with increased risk of PDA.Conclusion: High fluid intake (>170 ml kg À1 day À1 ) in the first days of life is associated with increased risk of PDA.

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Comparison of the effect of two fluid input regimens on perinatal lung function in ventilated infants of very low birthweight

Abstract: We conclude that early fluid restriction appears to have very little impact on perinatal lung function.

Cited by 17 publications

References 26 publications

Mild dehydration: a risk factor of broncho-pulmonary disorders?

Mild dehydration: a risk factor of broncho-pulmonary disorders?

Lung volumes in infants who had mild to moderate bronchopulmonary dysplasia

Fluid regimens in the first week of life may increase risk of patent ductus arteriosus in extremely low birth weight infants

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