Use and misuse of albumin infusions in neonatal care

Greenough, Anne

doi:10.1007/s004310050917

Cited by 42 publications

(21 citation statements)

References 32 publications

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“…A possible explanation is that colloid given in the perinatal period to infants with increased vascular permeability leaks into the lungs worsening respiratory function,21necessitating higher levels of respiratory support and hence predisposing the infant to CLD. These results21 and the present ones further argue22 23 that clinicians should be extremely cautious about prescribing colloid infusions for critically ill patients.…”

Section: Discussionsupporting

confidence: 68%

Randomised trial of fluid restriction in ventilated very low birthweight infants

Kavvadia

2000

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Background-Fluid restriction has been reported to improve survival of infants without chronic lung disease (CLD), but it remains unknown whether it reduces CLD in a population at high risk of CLD routinely exposed to antenatal steroids and postnatal surfactant without increasing other adverse outcomes. Aim-To investigate the impact of fluid restriction on the outcome of ventilated, very low birthweight infants. Study design-A randomised trial of two fluid input levels in the perinatal period was performed. A total of 168 ventilated infants (median gestational age 27 weeks (range 23-33)) were randomly assigned to receive standard volumes of fluid (60 ml/kg on day 1 progressing to 150 ml/kg on day 7) or be restricted to about 80% of standard input. Results-Similar proportions of infants on the two regimens had CLD beyond 28 days (56% v 51%) and 36 weeks post conceptional age (26% v 25%), survived without oxygen dependency at 28 days (31% v 27%) and 36 weeks post conceptional age (58% v 52%), and developed acute renal failure. There were no statistically significant diVerences between other outcomes, except that fewer of the restricted group (19% v 43%) required postnatal steroids (p < 0.01). In the trial population overall, duration of oxygen dependency related significantly to the colloid (p < 0.01), but not crystalloid, input level; after adjustment for specified covariates, the hazard ratio was 1.07 (95% confidence interval 1.02 to 1.13). Conclusions-In ventilated, very low birthweight infants, fluid restriction in the perinatal period neither reduces CLD nor increases other adverse outcomes. Colloid infusion, however, is associated with increased duration of oxygen dependency. (Arch Dis Child Fetal Neonatal Ed 2000;83:F91-F96) Keywords: chronic lung disease; prematurity; very low birthweight; fluid restriction; lungs; survival High volumes of fluid input increase the likelihood of a patent ductus arteriosus (PDA), 1 a known risk factor for the development of chronic lung disease (CLD).2 It is therefore surprising that fluid restriction in only one 3 of four 1 3-5 randomised trials was associated with improved outcome. Interestingly, the positive eVect was a lower mortality rather than a lower CLD rate.3 The population investigated were relatively mature and it is not clear how many were exposed to antenatal steroids or postnatal surfactant.3 Fluid restriction has a number of important possible side eVects, including hypovolaemia which could result in renal impairment. We therefore felt it important to determine, in a high risk population, whether fluid restriction compared with a more liberal regimen was associated with a lower incidence of CLD but no increase in other adverse outcomes. MethodsA randomised trial of two levels of fluid input was undertaken. Infants born prematurely with a birth weight of < 1500 g, without major congenital anomalies and requiring ventilation from within the first six hours of birth were eligible for entry into the study. If informed written consent was given by the pa...

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Section: Discussionsupporting

confidence: 68%

Randomised trial of fluid restriction in ventilated very low birthweight infants

Kavvadia

2000

Archives of Disease in Childhood - Fetal and Neonatal Edition

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“…We now demonstrate by the results of serial measurements that colloid administration actually adversely aected lung function. The present results, therefore, further suggest [9,19] that clinicians should be extremely cautious about prescribing colloid infusions to critically ill patients.…”

Section: Discussionmentioning

confidence: 59%

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

et al. 1999

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“…Several authors have described an inverse relationship between albumin concentrations and mortality and morbidity, although the cause of the hypoalbuminemia, rather than the low albumin concentrations itself, may be responsible [3,4]. However, exogenous albumin infusion in preterm infants with hypoalbuminemia does not seem to reduce mortality and morbidity [1,5,6]. The endogenous stimulation of albumin synthesis might be more effective.…”

Section: Introductionmentioning

confidence: 92%

Albumin synthesis in very low birth weight infants is enhanced by early parenteral lipid and high-dose amino acid administration

et al. 2016

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Use and misuse of albumin infusions in neonatal care

Abstract: The neonatologist would be well advised, when reaching for an albumin infusion, to reflect that there may be a safer, certainly cheaper and equally effective alternative.

Cited by 42 publications

References 32 publications

Randomised trial of fluid restriction in ventilated very low birthweight infants

Randomised trial of fluid restriction in ventilated very low birthweight infants

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

Albumin synthesis in very low birth weight infants is enhanced by early parenteral lipid and high-dose amino acid administration

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