RANDOMIZED CONTROLLED TRIAL - COMPARISON OF COLLOID OR CRYSTALLOID FOR PARTIAL EXCHANGE-TRANSFUSION FOR TREATMENT OF NEONATAL POLYCYTHEMIA

Aim-To compare the efficacy of using isotonic saline (crystalloid) or 5% albumin (colloid) as replacement fluid in partial exchange transfus ion (PET) for the treatment of neonatal polycythaemia. Methods-One hun dred and two polycythaemic full term infants were randomly allocated t o receive PET with either isotonic saline or 5% albumin. The criteria for PET were: (a) venous haematocrit greater than or equal to 0.7; or (b) venous haematocrit 0.65-0.69 with symptoms or signs attributable t o polycythaemia. Results-PET with either saline (n=53) or 5% albumin ( n=50) resulted in a significant and sustained decline in haematocrit u p to 24 hours after PET. Although the immediate haemodilution effect o f isotonic saline was statistically smaller than that of 5% albumin (d ecline in haematocrit 19.3% vs 22.8% of pre-PET value), the difference was too small to be of any clinical significance, and the haematocrit at 4 or 24 hours after PET did not differ significantly between the t wo groups. PET with either replacement fluid was not associated with a ny complication. The serum sodium and potassium concentrations were no t significantly affected by the PET in either group. Conclusions-Both isotonic saline and 5% albumin are effective when used as replacement fluid in PET for the treatment of neonatal polycythaemia. Isotonic sal ine, which is cheaper and free of infection, should be the replacement fluid of choice.