Raktima Chakrabarti
Aims: Hydroxyethyl starch (HES), a plasma volume expander, is started to get explored as a treatment-option for neonatal hypovolemia in the present decade. The objective of the present study was to assess the effect of this agent on the immature renal system of neonatal population. The secondary objective was to compare the renal impact of HES to that of isotonic saline solution (ISS), the most-commonly used volume expander in neonatal intensive care units (NICU).
Methods: The current university-hospital based retrospective-study expanded over 1 year (January 2009 - December 2009) and involved 50 inborn neonates (gestational age ranged from 24-38 weeks, birth weight 440-4580 grams) with hypovolemia. HES and ISS both are used in our NICU according to clinician’s judgment. 25 neonates were chosen randomly from HES treated patients and 25 randomly from ISS treated cases. The exclusion criteria were: out born neonate, neonates with congenital anomaly of renal system, renal vein thrombosis, acute renal-tubular-necrosis, neonates simultaneously treated with veno-arterial extra-corporeal membrane oxygenation (ECMO) or nephrotoxic antibiotics, babies with diagnosed congenital syndrome complex, inborn error of metabolism. HES group neonates were treated with 4 ml/kg HES (200/0.5) over 30 minute and the others were with 10 ml/kg 0.9% normal saline Blood samples were collected from all of them before, immediately after, 24 hours, 7 days and 14 days after volume treatment to check serum creatinine level. Urine output was continuously monitored. At those time points their Glomerular filtration rate (GFR), and urinary output were also recorded. The collected data were analyzed statistically using Graph-pad prism 5.03.
Results:The result showed that there was no derogatory effect of HES either on immature kidney or on other systems.There was no significant difference among these two groups at any point of time with respect to GFR, serum creatinine or urine output (our considered renal functional parameters) .But both groups showed significant changes of these functions with respect to time, which could be a normal physiological maturation of kidney during neonatal period as a result of adjustment from fetal to postnatal life. In case of HES group, there was a minute fall of GFR and rise of creatinine immediately after treatment which could be due to HES induced down regulation of endogenous nitric-oxide production. But this was not statistically significant and did not give rise to any renal pathology.
Conclusion: A small-volume single-infusion of Hydroxyethyl starch is a good option for treating neonatal hypovolemia without any adverse effects and its impact on renal-function is comparable to isotonic saline. So it can be considered as an emergency medicine in NICU.
