The objective of a study published in the Journal of Paediatrics and Child Health was to assess the prevalence, types and indications for fluid bolus therapy in neonates with hemodynamic compromise.

In this pragmatic, international, multicenter 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 hemodynamic compromise (≥10 mL/kg given at ≤6 h) were included.

Overall, 163 neonates received a bolus, over 8 479 eligible patient days in 41 neonatal units. The results showed that the prevalence of fluid bolus therapy varied between centers from 0 to 28.6% of admitted neonates per day, with a pooled prevalence rate of 1.5%. The most common fluid used was 0.9% sodium chloride (79%). The volume of fluid administered was most commonly 10 mL/kg (71%) over a median of 30 min (interquartile range 20-60). The most frequent indications were hypotension (34%), poor perfusion (12%) and metabolic acidosis (12%). Minimal or no clinical improvement was reported by clinicians in 66 of 163 cases (40%).

In inference, it was stated that wide international variations in types, indications and effects of fluid bolus administration in hemodynamically compromised neonates suggest uncertainty in the risk-benefit profile. This is likely to reflect the lack of adequate evidence to support the efficacy of different fluid types, doses and appropriate indications.

Source: Journal of Paediatrics and Child Health. 2019 Jun;55(6):632-639. doi: 10.1111/jpc.14260.