The efficacy and safety of isotonic and hypotonic fluids in intravenous maintenance fluid therapy in term newborns: national multicenter observational 'neofluid' study

Autor: Hasan Ozkan, Nuray Duman, Funda Tuzun, Fatma Narter, Can Akyildiz, Emel Altuncu, Mehmet Satar, Mustafa Ozdemir, Abdullah Kurt, Ali U. Tugcu, Murat Konak, Saime Sundus Uygun, Seda Yilmaz Semerci, Rahime T. Dikmen, Bora Baysal, Cemile K. Zeybek, Yasemin Ezgi Kostekci, Suzan Sahin, Merve Tutal, Ayse Anik, Mehmet Buyuktiryaki, Belma S. Karagol, Gaffari Tunç, Derya Colak, Hasan Cetin, Aysen Orman, Ozgur Olukman, Mehmet Fatih Deveci, Dilek Sarici, Salih C. Cakir, Pembe Keskinoglu
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: Frontiers in Nutrition, Vol 11 (2024)
Druh dokumentu: article
ISSN: 2296-861X
DOI: 10.3389/fnut.2024.1410571
Popis: ObjectiveThe objective of this study was to evaluate the efficacy and safety of isotonic and hypotonic intravenous fluids in maintenance fluid therapy for term infants.MethodsThis was a multi-centre, prospective, observational study conducted in 21 participating centres from December 30, 2020, to June 30, 2023. The study included term newborns requiring parenteral fluid therapy for maintenance (NCT04781361). The fluid treatment was divided into two groups based on the concentration of sodium in the parenteral fluid, designated as hypotonic (NaCl 145 mmol/L), and the occurrence of clinically significant changes in sodium levels (∆pNa >0.5 mmol/L/h).ResultsA total of 420 patients from 21 centers were included. The ∆pNa was negative in the hypotonic fluid group and positive in the isotonic fluid group, with a significant difference between the groups [respectively −0.07 ± 0.03 (95% CI: −0.13 to −0.02); 0.04 ± 0.03 (95%CI: −0.02 to 0.09), p = 0.04]. There was no difference between the groups in terms of the development of hypernatremia or a clinically meaningful pNa increase. The hypotonic fluid group had a higher incidence of hyponatremia and a clinically meaningful sodium decrease compared to the isotonic fluid group [7.9% vs. 1.2% (OR:6.5, p:0.03)] and [12.2% vs.4.2% (OR:2.9, p = 0.03)].ConclusionContrary to current understanding, this large-scale study is the first to demonstrate that the use of hypotonic fluids in maintenance fluid therapy for newborns poses a risk of hyponatremia development, whereas isotonic fluid therapy appears safe.
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