Neonatal Infusion Therapy

Abstract

Objective: to study whether 20% albumin might be postoperatively used in the newborn. Subjects and methods. The study included 64 neonatal infants with various congenital surgical diseases: esophageal atresia (34.1%), congenital low and high ileus (43.9%), diaphragmatic hernia (12.1%), and gastroschisis (5.7%). On days 1 and 2 after birth, all the infants underwent correction of a defect. The rate of neonatal shock elimination was studied, by using the traditional scheme and transfusion of highly concentrated 20% albumin solution (20% plasbumin (Talecris Biotherapeutics). A study group comprised 12 neonates aged 0 to 3 days. For stabilization of blood pressure and emergence from shock, they received highly concentrated 20% albumin solution by the authors’ scheme (at an infusion rate of 20 ml/kg/hour until BP stabilized) in the early postoperative period. A control group consisted of 52 neonatal infants who had the similar surgical interventions and received the complete standard complex of infusion-transfusion therapy: 10% glucose + physiological solution in a ratio of 1:1 at a rate of 20 ml/kg/hour, then 6% hydroxyethyl starch preparations in a dose of 3 ml/kg/hour. The control points in the study were as follows: mortality rate, the rate of normalization of BP and diuresis within the first 24 hours after surgery, the severity of generalized edema and the stabilization of total blood protein by day 10, and the duration of artificial ventilation (AV). All the neonates underwent monitoring of vital indices: ECG, systolic, diastolic, and mean BP, and tissue oxygen saturation (SaO2). Statistical processing involved estimation of the significance of changes, by using Student’s test. Results. Mortality rates were 9.8 and 22.3% in the group of neonates receiving 20% albumin against shock and in the control having the traditional treatment, respectively. A significant acceleration of BP normalization was noted in the study group (1.5±0.12 hours) as compared with the control group (26±3.6 hours) (p<0.001). In this group, generalized edema was also more rapidly abolished (on day 3) and blood protein stabilized to 54 g/l by day 4 of therapy. In the control group, these indices were achieved b days 7—9 of therapy. In addition, the duration of AV averaged 3 days in the study group and 7 days in the control group. It should be noted that in the study group the average volume of antishock infusion for BP stabilization was 70±7.3 ml or a third of daily liquid intake (DLI). In the control group, it was significantly higher: 180±9.5 ml or 1V4 of DLI (p<0.05). Conclusion. When highly concentrated albumin was used, no undesirable effects were observed in neonatal infants in the early postoperative period. In shock, 20% albumin promptly stabilized hemodynamic parameters, corrected hypoproteinemia, and reduced the duration of AV. With 20% albumin being used, the low volume of volemic load makes it possible to adequately correct electrolytic disorders and to initiate partial parenteral feeding as early as possible to compensate for energy expenditures. Key words: neonatal infants, shock, 20% albumin, hypovolemic states, neonatal intensive care, congenital malformations, neonatal surgery.