Comparison of the Isotonic and Hypotonic Intravenous Maintenance Fluids In Term Newborns: Neofluid Study

NCT ID: NCT04781361

Last Updated: 2023-07-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

420 participants

Study Classification

OBSERVATIONAL

Study Start Date

2020-12-30

Study Completion Date

2023-06-30

Brief Summary

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Considering the physiological changes in fluid and electrolyte balance and providing proper support are one of the important aspects of neonatal intensive care. Maintenance intravenous fluids are designed to maintain homeostasis when a patient is unable to uptake required water, electrolytes, and energy. Hypotonic fluids are still the most commonly prescribed IV fluids for pediatric hospitalized patients. However, previous studies, including children older than one month of age revealed that traditionally used hypotonic fluids may lead to hyponatremia.

Because of the absence of evidence-based data, there is currently no clear consensus on the optimal composition of maintenance intravenous fluid therapy in newborns, leading to wide practice variation.

The National Clinical Guideline Center (NICE) 2015 recommends the use of isotonic fluids in term newborn infants and some newborn centers has begun to use isotonic fluids since guidelines recommendations. Since the publication of the NICE guideline, no studies have addressed this topic.

In this prospective, observational , multicentric study, conventional hypotonic fluids containing sodium chloride (NaCl) \< 130 mmol/L compared with isotonic fluids (containing NaCl between 131-154 mmol/L) in terms of the risk of hyponatremia, hypernatremia, plasma sodium (pNa) level change, treatment morbidities, hospitalization duration and mortality.

Detailed Description

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Conditions

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Newborn Complication Hyponatremia of Newborn Hypernatremia of Newborn Fluid Therapy Sodium Chloride Isotonic Dehydration

Study Design

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Observational Model Type

CASE_CONTROL

Study Time Perspective

PROSPECTIVE

Study Groups

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Isotonic fluid

Group, received isotonic maintenance fluid containing NaCl between 131 to 154 mmol/L such as:

* Dextrose 5% in 0.9% NaCl,
* Intravenous fluid containing NaCl between 131 to 154 mmol/L

Intravenous isotonic fluid - NaCl 131-154 mmol/L in 5% dextrose

Intervention Type DRUG

Isotonic group will be given fluids containing 131-154 mmol/L Sodium Chloride

Hypotonic fluid

Group, received hypotonic maintenance fluid containing NaCl \< 130 mmol/L such as:

* Dextrose 5 % in 0.02 % NaCl,
* Dextrose 5% in 0.033 % NaCl
* Dextrose 5% in 0.045 % NaCl
* Intravenous fluid containing NaCl \< 130 mmol/L

Intravenous Hypotonic fluid- Sodium Chloride < 130 mmol/L

Intervention Type DRUG

Hypotonic group will be given fluids containing lower than 130 mmol/L :

Dextrose 5% in 0.2% Sodium Chloride, or Dextrose 5% in 0.33 % Sodium Chloride,or Dextrose 5% in %0.45 Sodium Chloride, or Intravenous fluid containing Sodium Chloride \< 130 mmol/L

Interventions

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Intravenous isotonic fluid - NaCl 131-154 mmol/L in 5% dextrose

Isotonic group will be given fluids containing 131-154 mmol/L Sodium Chloride

Intervention Type DRUG

Intravenous Hypotonic fluid- Sodium Chloride < 130 mmol/L

Hypotonic group will be given fluids containing lower than 130 mmol/L :

Dextrose 5% in 0.2% Sodium Chloride, or Dextrose 5% in 0.33 % Sodium Chloride,or Dextrose 5% in %0.45 Sodium Chloride, or Intravenous fluid containing Sodium Chloride \< 130 mmol/L

Intervention Type DRUG

Other Intervention Names

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B05BB02, 0.9% NaCl/Dextrose 5% B05BB02, 0.45% NaCl/5% dextrose B05BB02, 0.33 % NaCl/5% dextrose B05BB02, 0.20 % NaCl/5% dextrose

Eligibility Criteria

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Inclusion Criteria

* Term newborns (\>37 + 0/7 weeks) aged 24 hours to 30 days with a normal baseline serum sodium level between 135-145 mmol/L,with a treatment plan to include IV fluids at \> 50% of maintenance
* Infants not received parenteral fluids in the last 24 hours before participation
* Infants receiving IV fluid administration at 50% to 100% of maintenance

Exclusion Criteria

* Newborns with diagnoses that required specific fluid tonicity and volumes such as:

* Severe dehydration presenting with shock
* Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
* Renal insufficiency
* Adrenal insufficiency
* Diabetes mellitus and diabetes insipidus
* Hypoxic ischemic encephalopathy
* Major congenital anomaly
* Patients receiving diuretic therapy
* Patients with obvious edema
* Heart or liver failure, portal hypertension with acid
* Pre-post operative patients
* Infants receiving total parenteral nutritional therapy
* Other: all conditions that require non-standard liquid content and quantities
Minimum Eligible Age

1 Day

Maximum Eligible Age

30 Days

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Izmir Katip Celebi University

OTHER

Sponsor Role collaborator

Dr. Behcet Uz Children's Hospital

OTHER

Sponsor Role collaborator

Eskisehir Osmangazi University

OTHER

Sponsor Role collaborator

Necmettin Erbakan University

OTHER

Sponsor Role collaborator

NCR International Hospital

UNKNOWN

Sponsor Role collaborator

Uşak University

OTHER

Sponsor Role collaborator

Zekai Tahir Burak Women's Health Research and Education Hospital

OTHER

Sponsor Role collaborator

Aydin Adnan Menderes University

OTHER

Sponsor Role collaborator

Inonu University

OTHER

Sponsor Role collaborator

Baskent University

OTHER

Sponsor Role collaborator

Kecioren Education and Training Hospital

OTHER

Sponsor Role collaborator

Istanbul University

OTHER

Sponsor Role collaborator

Istanbul Medeniyet University

OTHER

Sponsor Role collaborator

Dr. Lutfi Kirdar Kartal Training and Research Hospital

OTHER_GOV

Sponsor Role collaborator

Kanuni Sultan Suleyman Training and Research Hospital

OTHER

Sponsor Role collaborator

Medipol University

OTHER

Sponsor Role collaborator

Cukurova University

OTHER

Sponsor Role collaborator

Mersin Training and Research Hospital

OTHER_GOV

Sponsor Role collaborator

Cigli Regional Training Hospital

OTHER

Sponsor Role collaborator

Gulhane School of Medicine

OTHER

Sponsor Role collaborator

Ministry of Health University, Bursa Yüksek İhtisas Training and Research Hospital

UNKNOWN

Sponsor Role collaborator

Yuksek Ihtisas University

OTHER

Sponsor Role collaborator

Ministry of Health University, Kayseri Regional Hospital

UNKNOWN

Sponsor Role collaborator

Suleyman Demirel University

OTHER

Sponsor Role collaborator

Konya Private Medova Hospital

UNKNOWN

Sponsor Role collaborator

Ankara Yildirim Beyazıt University

OTHER

Sponsor Role collaborator

Cumhuriyet University

OTHER

Sponsor Role collaborator

Aydın Maternity and Children Hospital

UNKNOWN

Sponsor Role collaborator

Umraniye Education and Research Hospital

OTHER_GOV

Sponsor Role collaborator

Selcuk University

OTHER

Sponsor Role collaborator

Mersin University

OTHER

Sponsor Role collaborator

Istanbul University - Cerrahpasa

OTHER

Sponsor Role collaborator

Dokuz Eylul University

OTHER

Sponsor Role lead

Responsible Party

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Funda Tuzun

M.D., Associate Professor of Neonatology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Hasan Ozkan, Prof.

Role: PRINCIPAL_INVESTIGATOR

Dokuz Eylül University- Faculty of Medicine

Locations

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Dokuz Eylul University

Izmir, , Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

References

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National Clinical Guideline Centre. IV Fluids in Children: Intravenous Fluid Therapy in Children and Young People in Hospital. London: National Institute for Health and Care Excellence (UK); 2015 Dec. Available from http://www.ncbi.nlm.nih.gov/books/NBK338141/

Reference Type BACKGROUND
PMID: 26741016 (View on PubMed)

Balasubramanian K, Kumar P, Saini SS, Attri SV, Dutta S. Isotonic versus hypotonic fluid supplementation in term neonates with severe hyperbilirubinemia - a double-blind, randomized, controlled trial. Acta Paediatr. 2012 Mar;101(3):236-41. doi: 10.1111/j.1651-2227.2011.02508.x. Epub 2011 Nov 19.

Reference Type BACKGROUND
PMID: 22040311 (View on PubMed)

McNab S, Ware RS, Neville KA, Choong K, Coulthard MG, Duke T, Davidson A, Dorofaeff T. Isotonic versus hypotonic solutions for maintenance intravenous fluid administration in children. Cochrane Database Syst Rev. 2014 Dec 18;2014(12):CD009457. doi: 10.1002/14651858.CD009457.pub2.

Reference Type BACKGROUND
PMID: 25519949 (View on PubMed)

Tuzun F, Akcura Y, Duman N, Ozkan H. Comparison of isotonic and hypotonic intravenous fluids in term newborns: is it time to quit hypotonic fluids. J Matern Fetal Neonatal Med. 2022 Jan;35(2):356-361. doi: 10.1080/14767058.2020.1718094. Epub 2020 Mar 29.

Reference Type BACKGROUND
PMID: 32223482 (View on PubMed)

Other Identifiers

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363-SBKAEK

Identifier Type: -

Identifier Source: org_study_id

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