Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Does fluid restriction improve outcomes in infants with hypoxic ischemic encephalopathy? A pilot randomized controlled trial

Journal of Perinatology volume 38, pages 1512–1517 (2018)Cite this article

Subjects

Abstract

Objective

To evaluate whether a strategy of restricted fluid intake in the first 4 days reduces mortality and morbidity among term neonates with moderate to severe hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia.

Study design

Eighty neonates with HIE were randomized between January 2016 and February 2018 to receive normal fluid intake (n = 40) or restricted fluid intake (two-third of normal intake; n = 40) in the first 4 days of life. The primary outcome was a composite of death or major neurodevelopmental disability at 6 months of age.

Results

The primary outcome occurred in 10 infants (26%) in the fluid-restricted group and 3 infants (8%) in the normal fluid intake group, but the difference was not statistically significant (p = 0.065). Five infants in the fluid-restricted group had hypoglycemia (p = 0.055).

Conclusion

Restricted fluid intake did not reduce the composite outcome of death or neurodevelopmental disability and was associated with a trend toward more hypoglycemia.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Lawn JE, Blencowe H, Oza S, You D, Lee AC, Waiswa P, et al. Every newborn: progress, priorities, and potential beyond survival. Lancet. 2014;384:189–205.

    Article  PubMed  Google Scholar 

  2. Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev. 2013;CD003311.

  3. Kecskes Z, Healy G, Jensen A. Fluid restriction for term infants with hypoxic-ischaemic encephalopathy following perinatal asphyxia. Cochrane Database Syst Rev. 2005;CD004337.

  4. Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med. 2005;353:1574–84.

    Article  CAS  PubMed  Google Scholar 

  5. Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:59–59.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Phatak P, Misra N. Developmental assessment scales for Indian infants (DASII) 1-30 months. Revision of Baroda norms with indigenous material. Psychol Stud. 1996;41:55–56.

    Google Scholar 

  7. Juneja M, Mohanty M, Jain R, Ramji S. Ages and stages questionnaire as a screening tool for developmental delay in Indian children. Indian Pediatr. 2012;49:457–61.

    Article  PubMed  Google Scholar 

  8. Thompson-Branch A, Havranek T. Neonatal hypoglycemia. Pediatr Rev. 2017;38:147–57.

    Article  PubMed  Google Scholar 

  9. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986;33:179–201.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Ayus JC, Achinger SG, Arieff A. Brain cell volume regulation in hyponatremia: role of sex, age, vasopressin, and hypoxia. Am J Physiol Ren Physiol. 2008;295:F619–24.

    Article  CAS  Google Scholar 

  12. Martinello K, Hart AR, Yap S, Mitra S, Robertson NJ. Management and investigation of neonatal encephalopathy: 2017 update. Arch Dis Child Fetal Neonatal Ed. 2017;102:F346–58.

    Article  PubMed  Google Scholar 

  13. Basu P, Som S, Choudhuri N, Das H. Contribution of the blood glucose level in perinatal asphyxia. Eur J Pediatr. 2009;168:833–8.

    Article  CAS  PubMed  Google Scholar 

  14. Basu SK, Kaiser JR, Guffey D, Minard CG, Guillet R, Gunn AJ. Hypoglycaemia and hyperglycaemia are associated with unfavourable outcome in infants with hypoxic ischaemic encephalopathy: a post hoc analysis of the CoolCap Study. Arch Dis Child Fetal Neonatal Ed. 2016;101:F149–155.

    Article  PubMed  Google Scholar 

  15. Durkan AM, Alexander RT. Acute kidney injury post neonatal asphyxia. J Pediatr. 2011;158(2 Suppl):e29–33.

    Article  PubMed  Google Scholar 

  16. Tanigasalam V, Bhat V, Adhisivam B, Sridhar MG. Does therapeutic hypothermia reduce acute kidney injury among term neonates with perinatal asphyxia?--a randomized controlled trial. J Matern Fetal Neonatal Med. 2016;29:2545–8.

    PubMed  Google Scholar 

  17. Taylor J, Wright J, Woodrum D. Avery’s diseases of the newborn. 9 edn. Philadelphia: Elsevier Saunders; 2012.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India

    Vasanthan Tanigasalam, Nishad Plakkal & B. Vishnu Bhat

  2. Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India

    Palanivel Chinnakali

Authors
  1. Vasanthan Tanigasalam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nishad Plakkal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Vishnu Bhat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Palanivel Chinnakali
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

VT: Collected data and drafted the initial manuscript. NP: Conceived the study and drafted the final manuscript. VB: Monitored the study and revised the final manuscript. PC: Statistical analysis plan and analyzed the data. All authors approved the final manuscript.

Corresponding author

Correspondence to Nishad Plakkal.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tanigasalam, V., Plakkal, N., Vishnu Bhat, B. et al. Does fluid restriction improve outcomes in infants with hypoxic ischemic encephalopathy? A pilot randomized controlled trial. J Perinatol 38, 1512–1517 (2018). https://doi.org/10.1038/s41372-018-0223-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-018-0223-7

This article is cited by

Search

Advanced search

Quick links