RANDOMIZED CONTROLLED TRIAL OF COLLOID OR CRYSTALLOID IN HYPOTENSIVE PRETERM INFANTS

Aim-To compare the efficacy of a colloid (5% albumin) and a crystalloi d (isotonic saline) solution for treating hypotension in mechanically ventilated preterm infants. Methods-Sixty three preterm infants weighi ng 540 to 1950 g at birth and with gestational ages of 23 to 34 weeks, who developed hypotension (mean arterial pressure < 25, 30, and 35 mm Hg for infants with birthweight <1, 1-1.49, and 1.5-1.99 kg, respecti vely) within the first 2 hours of life, were randomly allocated to rec eive intravenous infusions at 10 ml/kg of either 5% albumin (group 1, n=32) or isotonic (0.9%) saline (group 2, n=31). Inotropic support wit h dopamine infusion was given if the infants remained hypotensive afte r a total of three infusions (30 ml/kg). Subsequent extra doses of vol ume expander in the form of 5% albumin was given, depending on the inf ant's blood pressure. Results-There was no difference in the volume of the test solutions required between the two groups. Outcome, as asses sed by the number of infants requiring inotropic support and death or chronic lung disease, did not differ between the groups. After inotrop ic support, however, group 1 required significantly more volume expand er to maintain normal blood pressure (median: 27.5 ml/kg vs 10 ml/kg; P=0.0187) and had a higher mean (SEM) percentage weight gain within th e first 48 hours of life (at 24 hours: 6.3(1.3)% vs 3.3(0.8)%; P=0.049 ; at 48 hours: 5.9(1.9)% VS 0.9(1.7)%; P=0.045). The difference in wei ght gain was significant at 48 hours even when only those infants not requiring inotropic support or extra 5% albumin were compared (group 1 : 1.5(1.5)%, group 2: -4.2(1.1)%; P = 0.027). Conclusions-Isotonic sal ine is as effective as 5% albumin for treating hypotension in preterm infants, and it has the additional advantage of causing less fluid ret ention in the first 48 hours.