Sterile Water Gastric Drip in Extremely Low Birthweight Premature Infants: A Randomized Trial

Abstract

This study was performed to test the hypothesis that sterile water gavage drip (SWGD) used in the fluid management of extremely low birthweight (ELBW) infants will decrease the incidence of hypernatremia. Secondary hypotheses included decreased hyperkalemia, hyperglycemia, and hyperbilirubinemia. Sixty ELBW infants were randomized before 36 hours of age to receive SWGD (up to 30 mL/kg/d) and intravenous fluid or conventional intravenous fluid management. SWGD was well tolerated in 89% of the infants. No difference was seen in the incidence of hypernatremia, hyperkalemia, hyperglycemia, or hyperbilirubinemia. A significant reduction in the incidence of treated patent ductus arteriosus (PDA) was noted in the study group (36% versus 69%; relative risk, 0.52; 95% confidence interval, 0.30 to 0.90; p = 0.02). SWGD may provide an alternative means of safely administering free water to the ELBW infant. The observed reduction in treated PDA requires further investigation.

Randomized trial of sterile water by gavage drip in the fluid management of extremely low birth weight infants

“…We had hypothesized that using SWGD may reduce the incidence of PDA based on findings from our previous randomized study. 12 The primary outcome for the current study, a treated PDA, occurred in about two-thirds of the infants in both groups. Although there could have been bias in the diagnosis of PDA as the attendings were not masked, the incidence of treated PDA in this study is comparable to that from the control group in our previous study 12 and also from our historical data.…”

“…12 The primary outcome for the current study, a treated PDA, occurred in about two-thirds of the infants in both groups. Although there could have been bias in the diagnosis of PDA as the attendings were not masked, the incidence of treated PDA in this study is comparable to that from the control group in our previous study 12 and also from our historical data. There are several potential explanations for the discordant findings from these studies, which were conducted at the same NICUs but used different maximum volumes of SWGD (30 vs 50 ml kg À1 per day).…”

“…The infants in the previous trial from our center were not included in this study. 12 All infants were analyzed in their assigned groups (intention-totreat). Data were analyzed using Number Cruncher Statistical Systems 2004, Kaysville, UT.…”

“…Other studies have used water by gavage drip as part of an enteral feeding regimen and found no complications associated with SWGD. [9][10][11] Olney et al 12 conducted the only published randomized trial of SWGD in 60 ELBW infants. In this trial, infants in the SWGD group could receive up to 30 ml kg À1 per day of SWGD.…”

Using Enteral Sterile Water Feeds for Hypernatremia in Extremely Low Birth-Weight Infants

“…Enteral SWFs help avoid the need for giving excessive IV fluid volume, which would result in changes in IV osmolality. 47 An increased in IV fluid volume could potentially increase the glucose infusion rate or sodium level if present in the IV fluid. Excessive fluid volume may contribute to further electrolyte imbalance, PDA, 48 and bronchopulmonary dysplasia.…”