QUESTION 2: Are intravenous fluid boluses beneficial in late preterm or term infants with suspected haemodynamic compromise?

Keir, Amy; Froessler, Bernd; Stanworth, Simon

doi:10.1136/archdischild-2015-309182

Cited by 3 publications

(8 citation statements)

References 8 publications

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“…While this therapy represents an established component of the management of haemodynamic compromise in neonates, the volume, type of fluid, timing and indications for this practice are not well described or understood. [1][2][3] A Cochrane review found no benefit from the use of early fluid bolus therapy in infants ≤32 weeks' gestation without haemodynamic compromise. 1 This review identified no available evidence to determine whether those with clear haemodynamic compromise might benefit from volume expansion compared to no volume expansion.…”

Section: What This Paper Addsmentioning

confidence: 99%

“…1 Another review, including two more recent studies not included in the previous meta-analysis, was again unable to establish any benefit from fluid bolus therapy in late preterm and term infants with signs of haemodynamic compromise. 3 There are well-documented concerns about the consequences of fluid bolus therapy in older children, but comparable data do not exist for neonates. It is possible that some fluid boluses provide no clinical benefit and may even cause harm.…”

Section: What This Paper Addsmentioning

confidence: 99%

“…Fluid boluses may include crystalloids such as 0.9% sodium chloride or colloids such as albumin or blood products, including plasma, which have different biochemical properties. While this therapy represents an established component of the management of haemodynamic compromise in neonates, the volume, type of fluid, timing and indications for this practice are not well described or understood . A Cochrane review found no benefit from the use of early fluid bolus therapy in infants ≤32 weeks' gestation without haemodynamic compromise .…”

mentioning

confidence: 96%

“…This review identified no available evidence to determine whether those with clear haemodynamic compromise might benefit from volume expansion compared to no volume expansion . Another review, including two more recent studies not included in the previous meta‐analysis, was again unable to establish any benefit from fluid bolus therapy in late preterm and term infants with signs of haemodynamic compromise . There are well‐documented concerns about the consequences of fluid bolus therapy in older children, but comparable data do not exist for neonates.…”

mentioning

confidence: 99%

“…2 The indications for, the type of fluids used and the short-term clinical outcomes of fluid bolus therapy are poorly understood. 3 There is increasing evidence in paediatric medicine that fluid bolus therapy may be either ineffective or harmful.…”

mentioning

confidence: 99%

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

Keir

Karam

Hodyl

et al. 2018

J Paediatrics Child Health

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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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Section: What This Paper Addsmentioning

confidence: 99%

Section: What This Paper Addsmentioning

confidence: 99%

mentioning

confidence: 96%

mentioning

confidence: 99%

mentioning

confidence: 99%

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

Keir

Karam

Hodyl

et al. 2018

J Paediatrics Child Health

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Respiratory Variation in Aortic Blood Flow Velocity in Hemodynamically Unstable, Ventilated Neonates: A Pilot Study of Fluid Responsiveness

Oulego-Erróz¹,

Terroba-Seara

Alonso-Quintela

et al. 2020

Pediatric Critical Care Medicine

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Role of Volume Replacement during Neonatal Resuscitation in the Delivery Room

et al. 2022

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Volume expanders are indicated in the delivery room when an asphyxiated neonate is not responding to the steps of neonatal resuscitation and has signs of shock or a history of acute blood loss. Fetal blood loss (e.g., feto-maternal hemorrhage) may contribute to perinatal asphyxia. Cord compression or a tight nuchal cord can selectively occlude a thin-walled umbilical vein, resulting in feto-placental transfusion and neonatal hypovolemia. For severe bradycardia or cardiac arrest secondary to fetal blood loss, Neonatal Resuscitation Program (NRP) recommends intravenous volume expanders (crystalloids such as normal saline or packed red blood cells) infused over 5 to 10 min. Failure to recognize hypovolemia and subsequent delay in volume replacement may result in unsuccessful resuscitation due to lack of adequate cardiac preload. However, excess volume load in the presence of myocardial dysfunction from hypoxic–ischemic injury may precipitate pulmonary edema and intraventricular hemorrhage (especially in preterm infants). Emergent circumstances and ethical concerns preclude the performance of prospective clinical studies evaluating volume replacement during neonatal resuscitation. Translational studies, observational data from registries and clinical trials are needed to investigate and understand the role of volume replacement in the delivery room in term and preterm neonates. This article is a narrative review of the causes and consequences of acute fetal blood loss and available evidence on volume replacement during neonatal resuscitation of asphyxiated neonates.

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QUESTION 2: Are intravenous fluid boluses beneficial in late preterm or term infants with suspected haemodynamic compromise?

Cited by 3 publications

References 8 publications

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

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

Respiratory Variation in Aortic Blood Flow Velocity in Hemodynamically Unstable, Ventilated Neonates: A Pilot Study of Fluid Responsiveness

Role of Volume Replacement during Neonatal Resuscitation in the Delivery Room

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