Current opinion in pediatrics · 2004
Fluid and electrolyte therapy and chronic lung disease.
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Lorenz John M
Аннотация
PURPOSE OF REVIEW: To evaluate the role of fluid and electrolyte therapy in the pathogenesis of chronic lung disease.
RECENT FINDINGS: There have been no new studies since 2000, and there are minimal data addressing this issue specifically in infants at highest risk of chronic lung disease (ie, extremely low birth weight infants). Most observational studies demonstrate a significant association between increased fluid intake or differences in measures of changes in total body water balance in the first week of life and chronic lung disease. However, a metaanalysis of three randomized, controlled clinical trials did not reveal a significant increase in the risk of chronic lung disease with higher fluid intakes. The results of two randomized, controlled trials of different sodium intakes were conflicting regarding whether increased intake led to an increased prevalence of chronic lung disease.
SUMMARY: The evidence is insufficient to conclude that fluid and electrolyte therapy plays a role in the pathogenesis of chronic lung disease. Even if fluid and electrolyte therapy does play a small role, the data are insufficient to help with decisions about what fluid and electrolyte intake in an individual infant in a specific clinical setting might reduce the risk of chronic lung disease. However, net negative water and sodium balances and the resultant contraction of the extracellular space are probably physiologic in preterm infants in the first week of life and evidence suggests that a positive water and sodium balance and expansion of the extracellular space during this period increase morbidity. It is not clear what degree of contraction is appropriate or whether varying degrees of contraction of the extracellular space alter morbidity.
RECENT FINDINGS: There have been no new studies since 2000, and there are minimal data addressing this issue specifically in infants at highest risk of chronic lung disease (ie, extremely low birth weight infants). Most observational studies demonstrate a significant association between increased fluid intake or differences in measures of changes in total body water balance in the first week of life and chronic lung disease. However, a metaanalysis of three randomized, controlled clinical trials did not reveal a significant increase in the risk of chronic lung disease with higher fluid intakes. The results of two randomized, controlled trials of different sodium intakes were conflicting regarding whether increased intake led to an increased prevalence of chronic lung disease.
SUMMARY: The evidence is insufficient to conclude that fluid and electrolyte therapy plays a role in the pathogenesis of chronic lung disease. Even if fluid and electrolyte therapy does play a small role, the data are insufficient to help with decisions about what fluid and electrolyte intake in an individual infant in a specific clinical setting might reduce the risk of chronic lung disease. However, net negative water and sodium balances and the resultant contraction of the extracellular space are probably physiologic in preterm infants in the first week of life and evidence suggests that a positive water and sodium balance and expansion of the extracellular space during this period increase morbidity. It is not clear what degree of contraction is appropriate or whether varying degrees of contraction of the extracellular space alter morbidity.