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Pulmonary oedema is an important problem in premature neonates with surfactant deficiency because of fluid accumulation in the lung interstitium and reduced urine output. Some retrospective reports suggest that excessive early hydration might increase the risk of bronchopulmonary dysplasia (BPD). Only three prospective studies evaluating low or conventional fluid administration regimens to very low birth weight infants have been published. According to their results no significant differences in the incidence of BPD have been shown. However, fluid restriction seems to improve the outcome of the infants because of decreased incidence of haemodynamically significant patent ductus arteriosus, necrotizing enterocolitis, pulmonary air leaks and decreased mortality. The appropriate amount of sodium in the intravenous fluids during the first days of life needs further evaluation. In tiny infants with birth weights from 500 to 800g intensive monitoring of fluid balance is essential to control the extremely high fluid losses due to evaporation. Undernutrition is a risk factor of BPD and therefore it is important to start parenteral nutrition early. The benefit of the use of colloids as volume expanders is controversial. According to some retrospective reports there might be an association with increased use of colloidal fluids during the first days of life and the development of BPD. Early excessive fluid administration might constitute a potential risk for low birth weight infants with hyaline membrane disease.(ABSTRACT TRUNCATED AT 250 WORDS)

One hundred consecutive low birth weight (LBW) infants (less than 1751 g) were randomized into a study group having a restricted fluid intake until 4 weeks of age and a control group following the fluid regimen conventionally used in the hospital. Chest X-ray films were examined on admission, at the ages of 3 days, 7 days, 2 weeks and 4 weeks and at 2-monthly visits to the outpatient clinic up to 1 year of age or until the chest examinations were normal. The severity of hyaline membrane disease (HMD) and typical radiological abnormalities of bronchopulmonary dysplasia (BPD) were assessed. Twelve patients succumbed, one in the study group and 11 in the control group. The study group seemed experience less severe HMD than the controls. Fifty-four percent of the former and 32% of the latter were alive and had no radiological signs of BPD at 4 weeks of age (P less than 0.05). The difference between the groups in the cumulative number of normal chest X-ray examinations during the follow up was even more significant. The percentage of normal X-ray films at 1 year of age was 92% in the study group and 72% in the control group. These results suggest that fluid restriction for the first 4 weeks of life can lower the incidence of radiological abnormalities typical of BPD obtained during the 1st year of life in LBW infants. Pulmonary oedema seems to be a significant aetiological factor causing HMD to develop into chronic lung disease.

One hundred consecutive low-birth-weight infants (less than 1751 g) were randomized equally into "dry" and "control" groups. Fluid administration in the dry group followed the schema 50, 60, 70, 80, 90, 100 and 120 ml/kg/day during the first week and 150 ml/kg/day until aged four weeks and that of the control group 80, 100, 120 and 150 ml/kg/day during the first week and 200 ml/kg afterwards. The diagnosis of bronchopulmonary dysplasia was based on typical roentgenographic findings, clinical symptoms and a supplemental oxygen requirement at age one month. Mean weight loss was greater in the dry group than in the control group (8.8 vs 6.2%), but there was no difference in weight between the groups at the age of four weeks. Twelve of the patients died, one in the dry group and 11 in the control group (five died during the first 24 h and the remaining six between three days and three months). Twenty-seven subjects in the dry group and 15 in the control group were alive and had no signs of bronchopulmonary dysplasia at age 28 days (p less than 0.05), the numbers at term being 28 and 14, respectively (p less than 0.01). These results suggest that fluid restrictions can reduce the mortality and morbidity of low-birth-weight infants. Infants of this kind, with respiratory distress, show poor tolerance to fluids, especially during the first weeks of life.