Randomised controlled trial of colloid infusions in hypotensive preterm infants.

Abstract

Colloid infusions are often given to treat hypotension in preterm infants. The aim of this work was to assess whether it was the amount of protein or the volume of the colloid infused which accounted for the observed increase in blood pressure. Sixty preterm infants were randomised (20 in each group) to receive 5 ml/kg 20% albumin, 15 ml/kg fresh frozen plasma, or 15 mI/kg 4 5% albumin. All infusions were given at a rate of 5 ml/kg/hour in addition to maintenance fluids. The infants were randomised when hypotensive (systolic blood pressure less than 40 mm Hg for two hours). There was no significant difference in the blood pressure of the three groups before or one hour after beginning the infusion. The mean increase in blood pressure one hour after completing the infusion, however, was significantly lower in infants receiving 20% albumin: 9% compared with 17% in the group receiving 4-5% albumin, and 19% in the group receiving fresh frozen plasma. It is concluded that the volume infused rather than albumin load is important in producing a sustained increase in blood pressure. (Arch Dis Child 1992,67:1185 Colloid infusions are often used to treat hypotension in sick preterm infants. This hypotension may result from hypovolaemia due to fluid losses via the kidney and skin and increased leakage from capillaries in the lungs, or from myocardial depression due to asphyxia or hypoxia and resulting poor cardiac output. In the latter instance it seems preferable to avoid a large fluid load, but there are no data available to assess whether the improvement in blood pressure is the result of the protein or of the volume load infused. The aim of this study, therefore, was to compare the effects of colloid infusions of different volumes and protein content on blood pressure levels in hypotensive preterm infants and thus to determine the most efficacious type of colloid infusion. load. They were randomised by drawing a sealed envelope which instructed that they should receive one of three treatments: 5 ml/kg 20% albumin (200 g/l albumin-that is, 1 g/kg of albumin), or 15 ml/kg fresh frozen plasma (total protein 80 g/l, albumin 50 g/lthat is, 2 g/kg of protein or 0 75 g/kg of albumin), or 15 ml/kg 4 5% albumin (45 g/l albumin-that is, 0-675 g/kg of albumin). All infusions were given at a rate of 5 ml/kg/hour in addition to maintenance fluids. Thus the 20% albumin infusion was completed in one hour, but the other two infusions only after three hours. Systolic blood pressure was measured one hour after beginning the infusion and one hour after completing the infusion, and also four hours after beginning the infusions (that is, one hour after completing fresh frozen plasma and 4 5% albumin infusion, but three hours after completing the 20% albumin infusion).Systolic blood pressure was measured either from an indwelling arterial catheter sited for clinical purposes or using a non-invasive Doppler method. All blood pressure measurements were made with the infant in the supine position. Measurements were not made if the infa...

Randomized Trial of Volume Infusion During Resuscitation of Asphyxiated Neonatal Piglets

“…This differs from current NRP recommendations (1) that favor crystalloid infusion unless emergent O-negative blood is available. The findings are also different from those of three small randomized, controlled trials of NS versus ALB for the treatment of hypotension in acutely ill newborns in the NICU in which NS was found to be equivalent to ALB in improving blood pressure (9,34,35). Our findings may reflect acute increased oncotic pressure after ALB infusion compared with NS.…”

Haemodynamically unstable preterm infant: an unresolved management conundrum

“…As it may decrease afterload [45,46], newborns with primary myocardial dysfunction and elevated peripheral vascular resistance are most likely to benefit from dobutamine treatment [28,56]. Multiple randomized studies have shown that dopamine is more effective than dobutamine in increasing blood pressure in the preterm infant [3,9,19,62]. A meta-analysis of the findings of these four studies confirmed this and found that fewer infants in the dopamine-treated group had treatment failure [60].…”

Use and misuse of albumin infusions in neonatal care

“…Two studies [8,32] have demonstrated that it is the additional volume which is most in¯uential regarding BP improvement and those data [8,32], therefore, question the appropriateness of administering a colloid solution in such a clinical situation. In a randomized trial 5 ml/kg of 20% albumin (1 g/kg of albumin), 15 ml/kg of 4.5% albumin (0.675 g/kg albumin) and 15 ml/kg of fresh frozen plasma (2 g/kg protein) were administered to hypotensive (systolic BP <40 mmHg) preterm infants.…”