Does fluid restriction improve outcomes in infants with hypoxic ischemic encephalopathy? A pilot randomized controlled trial

Tanigasalam, Vasanthan; Plakkal, Nishad; Bhat, B. Vishnu; Chinnakali, Palanivel

doi:10.1038/s41372-018-0223-7

Cited by 18 publications

(10 citation statements)

References 15 publications

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“…The largest of these was a clinical trial from China involving 194 neonates [ 55 ], but this trial has been heavily criticized for protocol violations, post-randomisation exclusion and poor follow-up rates. Six of these cooling trials were from the same hospital, but with mortality in the usual care arm varying between 7 % and 50 %, raising concerns about data credibility and duplicate publications [ [56] , [57] , [58] , [59] , [60] , [61] ]. Hence, although the pooled data from these trials show a reduction in mortality with cooling, such a meta-analysis has no scientific value [ 62 , 63 ] ( Fig.…”

Section: Introductionmentioning

confidence: 99%

Need for more evidence in the prevention and management of perinatal asphyxia and neonatal encephalopathy in low and middle-income countries: A call for action

Krishnan

Kumar

Variane³

et al. 2021

Seminars in Fetal and Neonatal Medicine

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Although low- and middle-income countries (LMICs) shoulder 90 % of the neonatal encephalopathy (NE) burden, there is very little evidence base for prevention or management of this condition in these settings. A variety of antenatal factors including socio-economic deprivation, undernutrition and sub optimal antenatal and intrapartum care increase the risk of NE, although little is known about the underlying mechanisms. Implementing interventions based on the evidence from high-income countries to LMICs, may cause more harm than benefit as shown by the increased mortality and lack of neuroprotection with cooling therapy in the hypothermia for moderate or severe NE in low and middle-income countries (HELIX) trial. Pooled data from pilot trials suggest that erythropoietin monotherapy reduces death and disability in LMICs, but this needs further evaluation in clinical trials. Careful attention to supportive care, including avoiding hyperoxia, hypocarbia, hypoglycemia, and hyperthermia, are likely to improve outcomes until specific neuroprotective or neurorestorative therapies available.

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Section: Introductionmentioning

confidence: 99%

Need for more evidence in the prevention and management of perinatal asphyxia and neonatal encephalopathy in low and middle-income countries: A call for action

Krishnan

Kumar

Variane³

et al. 2021

Seminars in Fetal and Neonatal Medicine

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“…A subsequent RCT of infants with NE undergoing TH randomized infants to a restricted fluid intake of two thirds of normal (n = 40); at 40, 55, 65, and 80 mls per kilogram per day on post-natal days one to four of life, respectively, vs. normal fluid intake (n = 40); of 60, 80, 100, and 120 mls per kilogram per day, respectively, for the first four post-natal days of life. The fluid composition was 10% dextrose in the first 48 h of post-natal life with sodium and postassium added to the dextrose over the next 48 h. Restricted fluid did not reduce death or major neuro-disability at 6 months of age and was associated with a trend toward more hypoglycaemia (159). Hyponatraemia can result from kidney injury causing fluid retention, the syndrome of inappropriate anti diuretic hormone (SIADH), and tubular dysfunction.…”

Section: Renal Management In Nementioning

confidence: 99%

Management of Multi Organ Dysfunction in Neonatal Encephalopathy

et al. 2020

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Neonatal Encephalopathy (NE) describes neonates with disturbed neurological function in the first post-natal days of life. NE is an overall term that does not specify the etiology of the encephalopathy although it often involves hypoxia-ischaemia. In NE, although neurological dysfunction is part of the injury and is most predictive of long-term outcome, these infants may also have multiorgan injury and compromise, which further contribute to neurological impairment and long-term morbidities. Therapeutic hypothermia (TH) is the standard of care for moderate to severe NE. Infants with NE may have co-existing immune, respiratory, endocrine, renal, hepatic, and cardiac dysfunction that require individualized management and can be impacted by TH. Non-neurological organ dysfunction not only has a negative effect on long term outcome but may also influence the efficacy of treatments in the acute phase. Post resuscitative care involves stabilization and decisions regarding TH and management of multi-organ dysfunction. This management includes detailed neurological assessment, cardio-respiratory stabilization, glycaemic and fluid control, sepsis evaluation and antibiotics, seizure identification, and monitoring and responding to biochemical and coagulation derangements. The emergence of new biomarkers of specific organ injury may have predictive value and improve the definition of organ injury and prognosis. Further evidence-based research is needed to optimize management of NE, prevent further organ dysfunction and reduce neurodevelopmental impairment.

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“…2,3 However, there is no evidence to support this practice or to provide insight into the effect of fluid balance on outcomes of neonates with HIE. 4,5 This study by Ottolini et al aimed to determine any association between positive fluid balance and death or moderate to severe brain injury on post-rewarming magnetic resonance imaging (MRI) in neonates with HIE treated with TH. All neonates were initially administered fluids at a standard rate of 60 ml/kg/day.…”

Section: Commentarymentioning

confidence: 99%

Does fluid balance affect neurodevelopmental outcomes in hypoxic‐ischaemic encephalopathy?

Bachu

Hariharan

2021

Acta Paediatrica

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Does fluid restriction improve outcomes in infants with hypoxic ischemic encephalopathy? A pilot randomized controlled trial

Abstract: Restricted fluid intake did not reduce the composite outcome of death or neurodevelopmental disability and was associated with a trend toward more hypoglycemia.

Cited by 18 publications

References 15 publications

Need for more evidence in the prevention and management of perinatal asphyxia and neonatal encephalopathy in low and middle-income countries: A call for action

Need for more evidence in the prevention and management of perinatal asphyxia and neonatal encephalopathy in low and middle-income countries: A call for action

Management of Multi Organ Dysfunction in Neonatal Encephalopathy

Does fluid balance affect neurodevelopmental outcomes in hypoxic‐ischaemic encephalopathy?

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