Determination of indications for the transition to restrictive tactics of infusion therapy in critically ill preterm infants in the early neonatal period
P. I. Mironov,
Yu. S. Aleksandrovich,
R. G. Idrisova,
E. D. Galimova,
E. I. Gilmanova,
R. Z. Bogdanova https://doi.org/10.24884/2078-5658-2024-21-2-39-45
Abstract
Introduction. To date, reliable information about the “ideal” infusion therapy regimen for critically ill preterm infants in the early neonatal period is not known.
The objective was to determine the indications for the transition to restrictive tactics of infusion therapy in critically ill preterm infants
Materials and methods. The design was a prospective, observational study. The development included 110 newborns < 32 weeks of gestation (birth weight less than 1500 grams). 11 of them died.
Results. In deceased newborns, right ventricular mean pressure (RVMP) was higher in the first 3 days of intensive care and the left ventricular ejection fraction (LVEF) was higher by the third day of treatment they had a higher vasoactive inotropic index. The critical threshold value of RVMP was 29.0 mmHg. The “separation point” regarding the risk of death depending on the volume of infusion therapy was 100 ml/kg/day. The threshold value of the nSOFA score regarding the need to limit the volume of infusion therapy based on ROC analysis was 5.0 points.
Conclusion. Preterm infants with a high risk of death (nSOFA score > 5 points) require restrictive infusion therapy. The critical threshold value for the volume of fluid administered may be 100 ml/kg/day.
About the Authors
P. I. Mironov
Bashkir State Medical University Ministry
Russian Federation
Russian Federation
Mironov Petr I. Dr. of Sci. (Med.), Professor of the Department of Anesthesiology and Intensive Care with the course of the Institute of Additional Professional Education
3, Lenin str., Ufa, 450073
Yu. S. Aleksandrovich
St. Petersburg State Pediatric Medical University
Russian Federation
Russian Federation
Aleksandrovich Yuriy S. Dr. of Sci. (Med.), Professor, Head of the Department of Anesthesiology and Intensive Care and Emergency Pediatrics, Faculty of Postgraduate and Additional Professional Education
2, Litovskaya str., Saint Petersburg, 194100
R. G. Idrisova
Republic perinatal hospital
Russian Federation
Russian Federation
Idrisova Rozaliya G. Head of the Neonatal Intensive Care Unit
16, Avrova str., Ufa
E. D. Galimova
Republic perinatal hospital
Russian Federation
Russian Federation
Galimova Elvira D. Physician of Functional Diagnostic Department
16, Avrova str., Ufa
E. I. Gilmanova
Republic perinatal hospital
Russian Federation
Russian Federation
Gilmanova Elvira I. Physician of Functional Diagnostic Department
16, Avrova str., Ufa
R. Z. Bogdanova
Bashkir State Medical University Ministry
Russian Federation
Russian Federation
Bogdanova Ramila Z. Dr. of Sci. (Med.), Associate Professor of the Department of Faculty Pediatrics with the course of Neonatology
3, Lenin str., Ufa, 450073
References
1. Management of newborns with respiratory distress syndrome. Clinical Recommendations of RASPM / N. N. Volodin, eds. Мoscow, 2016. 48 p.
2. Idrisova R.G., Amirova V.R., Mironov P.I., Lekmanov A.U. Comparative assessment of the predictive ability of the nSOFA and NEOMOD scales in preterm newborns. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care, 2022, vol. 12, no. 3, pp. 351–359. DOI: 10.17816/psaic1278.
3. Abbas S., Amy K. K. In preterm infants, does fluid restriction, as opposed to liberal fluid prescription, reduce the risk of important morbidities and mortality? // Paediatrics and Child Health Division. – 2019. – Vol. 55, №7. – P. 860–866. DOI: 10.1111/jpc.14498.
4. Arjaans S., Fries M. W. F., Schoots M. H. et al. Clinical significance of early Pulmonary Hypertension in Preterm Infants // The Journal of Pediatrics. – 2022. – Vol. 251. – P. 74–81. DOI: 10.1016/j.jpeds.2022.07.039.
5. Bell E. F., Acarregui M. J. Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants // Cochrane Database Syst. Rev. – 2014. – Vol. 2014, № 2. – CD000503.
6. Diderholm B., Normann E., Ahlsson F. et al. The impact of restricted versus liberal early fluid volumes on plasma sodium, weight change, and short-term outcomes in extremely preterm infants // Nutrients. – 2022. – Vol. 14, № 4. – Р. 795. DOI: 10.3390/nu14040795.
7. Ismail R., Murthy P., Abou Mehrem A. et al. Fluid handling and blood flow patterns in neonatal respiratory distress syndrome versus transient tachypnea: a pilot study // BMC Pediatrics. – 2021. – Vol. 21. – P. 541. DOI: 10.1186/s12887-021-03025-z.
8. Kharrat A., Ripstein G., Baczynski M. et al. Validity of the vasoactive-inotropic score in preterm neonates receiving cardioactive therapies // Early Hum Dev. – 2022. – Vol. 173. – P. 351–357. DOI: 10.1016/j.earlhumdev.2022.105657.
9. Sanfilippo F., Rosa V., Grasso C. et al. Echocardiographic parameters and mortality in pediatric sepsis: a systematic review and meta-analysis // Pediatr Crit Care Med. – 2021. – Vol. 22, № 3. – Р. 251–261. DOI: 10.1097/PCC.0000000000002622.
10. Soullane S., Patel S., Claveau M. et al. Fluid status in the first 10 days of life and death/bronchopulmonary dysplasia among preterm infants // Pediatr. Res. – 2021. – Vol. 90. – P. 353–358.
11. Stroustrup A., Trasande L., Holzman I. R. Randomized controlled trial of restrictive fluid management in transient tachypnea of the newborn // J Pediatr. – 2012. – Vol. 160, № 1. – Р. 38–43.e1. DOI: 10.1016/j.jpeds.2011.06.027.
12. Sweet D. G., Carnielli V. P., Greisen G. et al. European Consensus Guidelines on the management of respiratory distress syndrome: 2022 Update // Neonatology. – 2023. – Vol. 120, № 1. – P. 3–23. DOI: 10.1159/000528914.
13. Wynn J. L., Mayampurath A., Carey K. et al. Validation of the neonatal sequential organ failure assessment score for prognosis in the neonatal intensive care unit // J Pediatr. – 2021. – Vol. 236, № 9. – P. 297–300. DOI: 10.1016/j.jpeds.2021.05.037.
Review
For citations:
Mironov P.I., Aleksandrovich Yu.S., Idrisova R.G., Galimova E.D., Gilmanova E.I., Bogdanova R.Z. Determination of indications for the transition to restrictive tactics of infusion therapy in critically ill preterm infants in the early neonatal period. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2024;21(2):39-45. (In Russ.) https://doi.org/10.24884/2078-5658-2024-21-2-39-45
Email this article 