Fluid restriction for term infants with hypoxic-ischaemic encephalopathy following perinatal asphyxia

 

Abstract

Background

Current recommendations to control the consequences of hypoxic-ischaemic encephalopathy following perinatal asphyxia include the careful management of fluids, with avoidance of fluid overload and thus avoidance of cerebral oedema. Recommendations for fluid restriction in a neonate are based on the experience of restricting fluid intake in adults or older children. The extrapolation from studies in adults, older children and animals to the human neonate is fraught with hazard due to the different physiology and mechanisms of injury.

Objectives

The objective of this review was to determine the effects of fluid restriction on short-term (mortality within the first 28 days of life, grade of hypoxic ischaemic encephalopathy, electrolyte disturbances, renal function, seizure activity) and long-term outcomes (death during the first year of life, CT or MRI changes, or severe neurodevelopmental disability at or equal to 12 months of age or more) in term infants following perinatal asphyxia. Subgroup analyses were planned on the basis of the severity of the resulting hypoxic-ischaemic encephalopathy, degree of fluid restriction, and length of fluid restriction.

Search methods

Searches were undertaken of MEDLINE October 2004 back to 1966, CINAHL back to 1966, the Oxford Database of Perinatal Trials and the Cochrane Central Register of Controlled Trial (CENTRAL, The Cochrane Library, Issue 3, 2004). Searches were made of previous reviews including cross-references and abstracts. The search was not limited to the English language; reports in foreign languages were translated.

Selection criteria

Randomised or quasi-randomised trials of fluid restriction in term newborn infants with perinatal asphyxia.

Data collection and analysis

No studies were found meeting the criteria for inclusion in this review.

Main results

No studies were found meeting the criteria for inclusion in this review.

Authors' conclusions

Given that fluid restriction for the treatment of hypoxic ischaemic encephalopathy following perinatal asphyxia is recommended in standard textbooks, there is a need for randomised, controlled trials to establish if this practice affects mortality and morbidity. As it may not be ethical to include neonates with acute renal failure in a randomised trial, these babies will have to be excluded from the trial. These studies should investigate the effects of fluid management on outcomes such as mortality, seizure activity, evidence of cerebral damage on histology, and effects on renal function and electrolytes.

 

Plain language summary

Fluid restriction for term infants with hypoxic-ischaemic encephalopathy following perinatal asphyxia

Plain language summary will be included with future review update.

 

摘要

背景

限制水分給予對周產期窒息後缺氧缺血性腦病變足月嬰兒的影響

在控制周產期窒息缺氧缺血性腦病變的足月嬰兒後遺症方面，現今照顧建議包括小心控制水分，避免水分過量以避免腦水腫。建議限制嬰兒水分的理論乃根據成人及較大兒童的經驗。將成人、較大兒童和動物的研究推論到新生兒，可能會因為其迥異的生理和損害機制不同而令人擔憂。

目標

此回顧的目的是為了評估有週產期窒息的足月嬰兒使用水分限制在短期 (出生28天內死亡率、缺氧缺血性腦病變程度、電解質不平衡、腎功能、癲癇活性) 及長期 (一年內死亡、CT及MRI變化、12個月或更大時的嚴重神經發展損害) 的效果。次群體分析計劃是根據缺氧缺血性腦病變結果的嚴重程度、水分制限的程度和時間。

搜尋策略

搜尋範圍包括於MEDLINE1966年至2004年10月、CINAHL 1966年起、牛津資料庫中有關周產期的研究和Cochrane Central Register of Controlled Trial (CENTRAL, The Cochrane Library, Issue 3, 2004) 。利用以前回顧文章，包括對照參考文獻和摘要來進行搜尋。搜尋不限於英文文獻，亦會翻譯其他語文。

選擇標準

在周產期窒息的足月新生兒限制水分使用的隨機或半隨機試驗。

資料收集與分析

沒有研究符合此篇回顧之標準。

主要結論

沒有研究符合此篇回顧之標準。

作者結論

雖然標準教科書建議給予周產期窒息後缺氧缺血性腦病變限水治療，然而仍需要隨機、控制研究來驗證此一作法對死亡率和罹病率的影響。因急性腎衰竭嬰兒納入隨機試驗可能不符合倫理，試驗時應將此些嬰兒排除。這些研究應該探討水分處理對預後如死亡率、癲癇、組織學上大腦傷害證據、腎功能和電解質的影響。

翻譯人

本摘要由馬偕醫院張龍翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

概要尚待完成