BackgroundAn increasing number of severe cases with IVH/PVL were observed in neonates at Rikshospitalet University Hospital during late 1990ies. Several of these were treated with dopamine/dobutamine shortly after birth. Some data in the literature implied a reduced risk of cerebral haemorrhage among older children treated with fluid therapy before inotropes. We believe that fluid resuscitation in the first 24-48 hours in neonates will result in a lower incidence of IVH/PVL than with dopamin/dobutamine alone.
Method We did a retrospective study including neonates >1500 grams treated at Rikshospitalet during 1994-2003. Data was collected from 109 patient charts. The inclusion criteria were 1) verified bacterial growth in blood culture and 2) documented hypotension either as drop in blood pressure >10 mmHg of MAP or documented as clinical signs of shock.
ResultPVL/IVH were observed in 6/44 of the neonates. Among these 3/6 were treated with both dopamine and fluids, 1/6 was treated with fluid and 2/6 received no therapy. 3/44 in our study died whereas 2/6 among those with IVH/PVL died. None in our study were treated with aggressive fluid resuscitation (>40 ml/kg). There was an increased incidence of prematurity, SGA, use of mechanical ventilation, apgar <5 at 5 minutes and p-PROM/PROM among those with IVH/PVL.
ConclusionOur data show that the incidence of IVH/PVL was less among the neonates treated with fluid compared to those treated with both dopamine and fluid therapy. However, there are few with IVH/PVL in our study and therefore we cannot provide conclusive recommendations.