EVIDENCE BASED MEDICINE

Cochrane Neonatal Reviews

Base administration or fluid bolus for preventing morbidity and mortality in preterm infants with metabolic acidosis

Metabolic acidosis in the early newborn period is associated with adverse outcomes in preterm infants. The most commonly used strategies to correct metabolic acidosis are intravascular infusion of base, for example sodium bicarbonate, and intravascular infusion of a fluid bolus, usually a crystalloid or colloid solution.

Objectives: To evaluate the available evidence from randomised controlled trials that either infusion of base, or of a fluid bolus, reduces mortality and adverse neurodevelopmental outcomes in preterm infants with metabolic acidosis.

Reviewers’ conclusions: There is insufficient evidence from randomised controlled trials to determine whether infusion of base or fluid bolus reduces morbidity and mortality in preterm infants with metabolic acidosis. Further large randomised trials are needed. (From the Cochrane Library, Review first published: Issue 2, 2005)

Early introduction of lipids to parenterally-fed preterm infants

Premature babies who are not yet ready to digest and absorb full milk feeds are given lipids through a vein to improve their nutrition. The issue of how early the lipids should be introduced to be advantageous while causing no harm is a matter of debate.

Lipids are essential components of parenteral nutrition for preterm infants. Parenteral lipids can be administered through a peripheral vein, and their early introduction offers the potential advantages of increasing energy intake and providing essential fatty acids and fat soluble vitamins. Concerns have been raised about potential adverse effects including chronic lung disease (CLD), increase in pulmonary vascular resistance, impaired pulmonary gas diffusion, bilirubin toxicity, sepsis and free radical stress.

Objectives: To determine the safety and efficacy of ‘early’ (= 5 days after birth) introduction of lipids to parenterally fed preterm infants.

Reviewers’ conclusions: No statistically significant effects of ‘early introduction’ of lipids on short term nutritional or other clinical outcomes, either benefits or adverse effects, were demonstrated in the studies reviewed. Based on the currently available evidence, ‘early’ initiation of lipids (= 5 days after birth) can not be recommended for short term growth or to prevent morbidity and mortality in preterm infants.
(From the Cochrane Library, Review first published: Issue 2, 2005)

Surfactant for meconium aspiration syndrome in full term infants

Objectives: To evaluate the effect of surfactant administration in the treatment of term infants with meconium aspiration syndrome.

Reviewers’ conclusions: In infants with meconium aspiration syndrome, surfactant administration may reduce the severity of respiratory illness and decrease the number of infants with progressive respiratory failure requiring support with ECMO. The relative efficacy of surfactant therapy compared to, or in conjunction with, other approaches to treatment including inhaled nitric oxide, liquid ventilation, and high frequency ventilation remains to be tested.

Chest physiotherapy for preventing morbidity in babies being extubated from mechanical ventilation

Synopsis: Active chest physiotherapy may not be helpful for all babies being taken off mechanical breathing support.

Mechanical ventilation (machine-assisted breathing) increases a baby’s lung secretions. Chest physiotherapy (tapping or vibrating on the chest) is thought to clear the baby’s lungs, and is often done when taking the baby off the ventilator (extubation). Although this review found a benefit for physiotherapy in terms of less babies needing to go back on the ventilator, no other benefits were shown. Also, this benefit was mainly due to the results of studies conducted a long time ago before advances such as better humidification systems to moisten the air the baby breaths and the drug surfactant. These advances may have reduced the risk of complications around the time of extubation so these results may not apply to babies in today’s neonatal nurseries. This review did not show any evidence of harm for babies receiving a short course of chest physiotherapy following extubation.
(Date edited: 22/02/2005)

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