Fluid restriction for treatment of preterm infants with chronic lung disease

Keith J Barrington; Etienne Fortin‐Pellerin; Thomas Pennaforte

doi:10.1002/14651858.CD005389.pub2

限制液体量治疗早产儿慢性肺病

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Referencias

References to studies included in this review

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otras referencias

Fewtrell MS, Adams C, Wilson DC, Cairns P, Mcclure G, Lucas A. Randomized trial of high nutrient density formula versus standard formula in chronic lung disease. Acta Paediatrica. 1997;86(6):577‐82. [PUBMED: 9202790]

Additional references

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estudios incluidos

Bancalari E. Neonatal chronic lung disease. In: Fanaroff A, Martin R editor(s). Neonatal‐Perinatal Medicine. 7th Edition. Vol. 2, St. Louis, Missouri: Mosby Inc, 2002:1057‐70.

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Gregory K. Update on nutrition for preterm and full‐term infants. Journal of Obstetric, Gynecologic, and Neonatal Nursing 2005;34(1):98‐108. [PUBMED: 15673653]

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Characteristics of studies

Characteristics of included studies [ordered by study ID]

Fewtrell 1997

Methods	Randomised controlled trial
Participants	60 preterm infants < 1500 grams and < 32 weeks, dependent on oxygen at more than 28 days of age
Interventions	Standard formula (24 kcal/oz) at 180 mL/kg/day compared to high nutrient‐density formula (30 kcal/oz) at 145 mL/kg/day
Outcomes	Growth variables, respiratory outcomes.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Pre‐determined randomisation sequence in block of 4 and 6.
Allocation concealment (selection bias)	Low risk	Randomisation sequences maintained in opaque envelopes.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Not feasible to mask the intervention.
Blinding of outcome assessment (detection bias) All outcomes	High risk	Outcome measures done by a research nurse not blind to the dietary randomisation.
Incomplete outcome data (attrition bias) All outcomes	Low risk	All subjects accounted for in the results.
Selective reporting (reporting bias)	Unclear risk	No published or registered protocol was found.
Other bias	Unclear risk	The lack on concealment may have had an impact on the intervention itself: the medical staff were apparently reluctant to increase daily fluids, so the high‐volume group did not receive as much fluid as planned.
Funding Source	Unclear risk	Study was funded by industry (Ross Laboratories) who also created the formulae. No indication is given about other roles of the funding source.

Data and analyses

Open in table viewer

Comparison 1. Fluid restricted compared to liberal fluids

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Duration of hospitalisation Show forest plot	1	60	Mean Difference (IV, Fixed, 95% CI)	3.0 [‐7.64, 13.64]
Open in figure viewer Analysis 1.1 Comparison 1 Fluid restricted compared to liberal fluids, Outcome 1 Duration of hospitalisation.
2 Daily weight gain Show forest plot	1	60	Mean Difference (IV, Fixed, 95% CI)	0.5 [‐1.22, 2.22]
Open in figure viewer Analysis 1.2 Comparison 1 Fluid restricted compared to liberal fluids, Outcome 2 Daily weight gain.
3 Proportion with apnoea Show forest plot	1	60	Risk Difference (M‐H, Fixed, 95% CI)	0.22 [‐0.00, 0.44]
Open in figure viewer Analysis 1.3 Comparison 1 Fluid restricted compared to liberal fluids, Outcome 3 Proportion with apnoea.

Figure 1

Study flow diagram.

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Analysis 1.1

Comparison 1 Fluid restricted compared to liberal fluids, Outcome 1 Duration of hospitalisation.

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Analysis 1.2

Comparison 1 Fluid restricted compared to liberal fluids, Outcome 2 Daily weight gain.

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Analysis 1.3

Comparison 1 Fluid restricted compared to liberal fluids, Outcome 3 Proportion with apnoea.

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Summary of findings for the main comparison. Fluid restricted compared to liberal fluids compared to placebo for treatment of preterm babies with chronic lung disease

Fluid restricted compared to liberal fluids compared to placebo for treatment of preterm babies with chronic lung disease
Participant or population: treatment of preterm babies with chronic lung disease Setting: Intervention: Fluid restricted compared to liberal fluids Comparison: placebo
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with placebo	Risk with fluid restricted compared to liberal fluids
Duration of oxygen therapy	The mean duration of oxygen therapy was 27.5 days	median 0.5 days higher (0 to 0 )	‐	60 (1 RCT)	⊕⊕⊝⊝ LOW ^{1 2}
Duration of hospitalisation	The mean duration of hospitalisation was 85 days	MD 3 Days higher (7.64 lower to 13.64 higher)	‐	60 (1 RCT)	⊕⊕⊝⊝ LOW ^{1 2}
Daily weight gain	The mean daily weight gain was 14.8 g/kg/d	MD 0.5 g/kg/d higher (1.22 lower to 2.22 higher)	‐	60 (1 RCT)	⊕⊕⊝⊝ LOW ^{1 2}
Proportion with apnoea	Study population		RR 1.35 (0.98 to 1.86)	60 (1 RCT)	⊕⊕⊝⊝ LOW ^{1 2}
	630 per 1000	850 per 1000 (617 to 1000)
	Moderate
	630 per 1000	850 per 1000 (617 to 1000)
*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect
¹ Unmasked study ² Wide confidence limits

Summary of findings for the main comparison. Fluid restricted compared to liberal fluids compared to placebo for treatment of preterm babies with chronic lung disease

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Comparison 1. Fluid restricted compared to liberal fluids

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Duration of hospitalisation Show forest plot	1	60	Mean Difference (IV, Fixed, 95% CI)	3.0 [‐7.64, 13.64]

2 Daily weight gain Show forest plot	1	60	Mean Difference (IV, Fixed, 95% CI)	0.5 [‐1.22, 2.22]

3 Proportion with apnoea Show forest plot	1	60	Risk Difference (M‐H, Fixed, 95% CI)	0.22 [‐0.00, 0.44]

Comparison 1. Fluid restricted compared to liberal fluids

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限制液体量治疗早产儿慢性肺病

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