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

被引：12

作者：

Keir, Amy K. ^{[1
,2
,3
]}

Karam, Oliver ^{[7
,8
]}

Hodyl, Nicolette ^{[1
,2
,23
]}

Stark, Michael J. ^{[1
,2
]}

Liley, Helen G. ^{[4
,5
,6
]}

Shah, Prakesh S. ^{[9
,10
]}

Stanworth, Simon J. ^{[11
,12
,13
]}

Morris, Scott ^{[14
]}

Carmo, Kathryn Browning ^{[15
]}

De Waal, Koert ^{[16
]}

Stubbs, Michelle ^{[16
]}

Liley, Helen ^{[17
]}

Pearson, Angela ^{[17
]}

Campbell, Holly ^{[17
]}

Hunt, Rodney W. ^{[18
]}

Perkins, Elizabeth ^{[18
]}

Ali, Sanoj K. M. ^{[19
]}

Bowen, Jennifer ^{[20
]}

Jacobs, Claire ^{[20
]}

Paradisis, Mary ^{[20
]}

Osborn, David ^{[21
]}

Greenhalgh, Mark ^{[21
]}

Kuschel, Carl ^{[22
]}

Hodyl, Nicolette ^{[1
,2
,23
]}

Stark, Michael ^{[23
]}

Keir, Amy ^{[23
]}

Ting, Joseph ^{[24
]}

Barrington, Keith ^{[25
]}

Lapointe, Anie ^{[25
]}

Dow, Kimberly ^{[26
]}

Coo, Helen ^{[26
]}

Mukerji, Amit ^{[27
]}

Mohamed, Adel ^{[28
]}

Stavel, Miroslav ^{[29
]}

Deshpandey, Akhil ^{[30
]}

Tucker, Nicole ^{[30
]}

Ng, Eugene ^{[30
]}

Diamond, Carly ^{[30
]}

Bourgoin, Pierre ^{[31
,32
]}

Bindl, Lutz ^{[31
,32
]}

Maria, Matthieu ^{[33
]}

De Luca, Daniele ^{[34
,35
]}

Dell'Orto, Valentina ^{[34
,35
]}

Ghirardello, Stefano ^{[36
]}

More, Kiran ^{[37
]}

Edmonds, Liza ^{[38
]}

Weaver, Lauren ^{[38
]}

Deschmann, Emoke ^{[39
,40
]}

Norman, Mikael ^{[39
,40
]}

Thomas, Owain ^{[41
]}

机构：

[1] Univ Adelaide, Adelaide Med Sch, Robinson Res Inst, Adelaide, SA, Australia

[2] Womens & Childrens Hosp, Dept Neonatal Med, 72 King William Rd, Adelaide, SA 5006, Australia

[3] South Australian Med & Res Inst, Hlth Mothers Babies & Children, Adelaide, SA, Australia

[4] Univ Queensland, Mater Res, Mater Mothers Hosp, Dept Neonatol, Brisbane, Qld, Australia

[5] Univ Queensland, Fac Clin Med, Brisbane, Qld, Australia

[6] Univ Queensland, Mater Res Inst, Brisbane, Qld, Australia

[7] Geneva Univ Hosp, Pediat Intens Care Unit, Geneva, Switzerland

[8] Virginia Commonwealth Univ, Childrens Hosp Richmond VCU, Div Pediat Crit Care Med, Richmond, VA USA

[9] Univ Toronto, Mt Sinai Hosp, Dept Paediat, Toronto, ON, Canada

[10] Univ Toronto, Dept Paediat, Toronto, ON, Canada

[11] Univ Oxford, NHS Blood & Transplant, Oxford, England

[12] Univ Oxford, Oxford Univ Hosp NHS Fdn Trust, Dept Haematol, Oxford, England

[13] Univ Oxford, Radcliffe Dept Med, Oxford, England

[14] Flinders Med Ctr, Bedford Pk, SA, Australia

[15] Childrens Hosp Westmead, Grace Ctr Newborn Care, Westmead, NSW, Australia

[16] John Hunter Childrens Hosp, New Lambton Hts, Australia

[17] Mater Mothers Hosp Brisbane, South Brisbane, Australia

[18] Royal Childrens Hosp, Melbourne, Vic, Australia

[19] Royal Hobart Hosp, Hobart, Tas, Australia

[20] Royal North Shore Hosp, St Leonards, NSW, Australia

[21] Royal Prince Alfred Hosp, Camperdown, NSW, Australia

[22] Royal Womens Hosp, Parkville, Vic, Australia

[23] Womens & Childrens Hosp, Adelaide, SA, Australia

[24] British Columbia Womens Hosp, Vancouver, BC, Canada

[25] Ctr Hosp Univ St Justine, Montreal, PQ, Canada

[26] Kingston Gen Hosp, Kingston, ON, Canada

[27] McMaster Childrens Hosp, Hamilton, ON, Canada

[28] Mt Sinai Hosp, Toronto, ON, Canada

[29] Royal Columbian Hosp, Westminster, BC, Canada

[30] Sunnybrook Hlth Sci Ctr, Toronto, ON, Canada

[31] Hop Femme Enfant & Adolescent, Neonatal Intens Care Unit, Nantes, France

[32] Hop Femme Enfant & Adolescent, Paediat Intens Care Unit, Nantes, France

[33] Reanimat Pediat Specialisee Hosp Enfants, Toulouse, France

[34] South Paris Univ Hosp, AP HP, Prais, France

[35] South Paris Saclay Univ, Div Pediat & Neonatal Crit Care, Ctr A Beclere, Prais, France

[36] Univ Milan, Fdn IRCCS Ca Granda Osped Maggiore Policlin, Neonatal Intens Care Unit, Dept Clin Sci & Community Hlth, Milan, Italy

[37] Christchurch Womens Hosp, Christchurch, New Zealand

[38] Dunedin Publ Hosp, South Dist Hlth Board, Dunedin, New Zealand

[39] Karolinska Univ Hosp Huddinge, Karolinska Univ Hosp Danderyd, Huddinge, Sweden

[40] Karolinska Univ Hosp, Astrid Lindgren Childrens Hosp, Solna, Sweden

[41] SUS Lund Univ Hosp, Lund, Sweden

[42] Hop Univ Geneve, Geneva, Switzerland

[43] Ostschweizer Sauglings & Kinderspital, St Gallen, Switzerland

[44] Hosp Pediat Coimbra, Coimbra, Portugal

[45] John Radcliffe Hosp, Oxford, England

[46] Boston Childrens Hosp, Boston, MA USA

[47] Emory Univ, Grady Mem Hosp, Emory Univ Midtown, Atlanta, GA 30322 USA

[48] Emory Univ, Pathol Dept, Ctr Transfus & Cellular Therapy, Atlanta, GA 30322 USA

[49] Levine Childrens Hosp, Carolinas Med Ctr, Charlotte, NC USA

[50] Univ Arkansas Med Sci, Little Rock, AR 72205 USA

来源：

JOURNAL OF PAEDIATRICS AND CHILD HEALTH | 2019年 / 55卷 / 06期

关键词：

blood pressure; fluid; infant; newborn; therapy; VOLUME EXPANSION; PRETERM INFANTS; INTRAVENTRICULAR HEMORRHAGE; ASSOCIATION; HYPOTENSION; LIFE; TERM;

D O I：

10.1111/jpc.14260

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

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.

引用

页码：632 / 639

页数：8

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