Continuous Gastric Infusion as an Alternative to Intravenous Infusion in Moderately Ill Term or near Term Infants
Monica Brundi, Claudio L. Solana, Alejandro Dinerstein, Nora C. Balanian, Miguel Larguia.
Neonatology, Htal. Materno Infantil Ramon Sarda, Buenos Aires, Argentina.
Most conditions affecting term or near term newborn babies who are moderately ill require short lengths of stay. Fluids and carbohydrates are initially administered by the intravenous route to maintain homeostasis.
We designed this trial to test the hypothesis that providing fluids and glucose as a continuous gastric infusion is as effective as the intravenous route for mantaining normal hydration and glucose levels.
Inborn babies with >1500 g and >34 weeks at birth, requiring an FiO2 less than 0.5 by hood (normoglycemic, not polycythemic and without gastrointestinal anomalies) were randomized to receive 80 ml/kg/day with 10% dextrose intravenously (IV group) or a similar amount of an isotonic solution (5% dextrose) by continuous gastric infusion (CGI group). Daily weight and serum electrolytes, every 6 hr blood glucose in the first day and every 12 hr in the next 48 hr were obtained. Failure of treatment was considered when hypo or hyper glycemia (<40 or >150 mg%, respectively), abnormal Na (serum Na >150 or <125 mEq/L), enteral intolerance or worsening of the RDS were present. Infants with treatment failure in the CGI group were crossed over to IV infusion.
From June 1999 to May 2003, 300 newborn babies were included in the study, 153 in the IV group and 147 in the CGI group. Birth weight, Apgar scores, gestational age, and sex were similar between groups. Failure rate was 10.2% in the CGI babies and 10.5% in the IV group (NS). Hypoglycemia was the main reason for failure in the CGI group (4.1%) vs. none in IV (p=.01). Rates of other complications were similar in both groups. Time to first milk feeding and total time of treatment were significantly shorter in the CGI than in the IV group, 19. vs 26 hr (p<.001) and 24 vs.38 hs (p<.001), respectively.
CGI and IV resulted in comparable failure rates but hypoglycemia was increased in the CGI infants. Administration of fluids and glucose by CGI may be an alternative for maintaining hydration and normoglycemia in moderately ill newborn babies. An extra benefit was the shorter length of treatment and time to initiation of enteral feeding. CGI may be a less painful procedure, free of local complications, easier to perform and less expensive than the IV route.