International, multicentre, observational study of fluid bolus therapy in neonates

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.

Recognition and management of neonatal hemodynamic compromise

“…13,14 Normal saline (0.9% NaCl) is the most commonly used crystalloid. 15 The high chloride content of normal saline (Table 1) can lead to hyperchloremic acidosis, and therefore, the acid-base status should be closely monitored when fluid bolus exceeds 20e30 mL/kg. Lactated Ringer has lower chloride content but is not adequately studied in the neonatal population.…”

Singapore Neonatal Resuscitation Guidelines 2021

“…(9,10) Both animal and human studies support the use of crystalloids over albumin as the first choice for volume expansion. (113)(114)(115)(116)(117) Recommendations on volume replacement • Early volume replacement in newborns is recommended following non-response to advanced resuscitation, even if blood loss is not apparent. • 10 mL/kg of 0.9% saline administered over 5-10 minutes is the first choice.…”

The practice of transfusion and fluid bolus therapy in neonates

“…As part of an initiative to understand the practice of fluid bolus therapy in both preterm and term neonates, a first multi-centre international cross-sectional observation of fluid bolus therapy for the management of suspected haemodynamic compromise in neonatal units was undertaken and presented in abstract form recently [56]. This study was an international, multi-centre, cross-sectional study undertaken at 41 neonatal units in Australasia, North America and Europe.…”