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Journal of the Korean Society of Neonatology 2004;11(2):113-121.
Published online November 1, 2004.
Fluid Therapy and Transfusion on Mechanical Ventilation.
Chun Soo Kim
Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea. cskim@dsmc.or.kr
인공 환기요법 중 수액요법 및 수혈
In newborn infants with mechanical ventilation in the first few days of life, fluid balance must be closely monitored because inadequate therapy related to overload may result in serious complications such as patent ductus arteriosus and pulmonary edema. Very low birth weight infants have significant change in body water balance in early neonatal period secondary to a large insensible water loss (IWL) and immaturity of renal function. Consequently these infants tend to have a high incidence of fluid overload so that fluid restriction with high humidification is effective during especially the first week of life. In infants with bronchopulmonary dysplasia, diuretics such as furosemide may act directly to improve lung mechanics by reabsorption of lung fluid, but chronic use may cause electrolyte imbalance, nephrocalcinosis and hearing deficit. In the early phase of perinatal asphyxia with oliguria, fluid restriction to amount equal to urine output and IWL is critical in order to prevent volume excess and potassium should not be given to avoid hyperkalemia. Blood components should always be infused through transfusion set with standard filter. To minimize adverse reactions of transfusion, basic rules must be observed. Moreover, storage of blood cells in small aliquots, using leukocyte removal filters and irradiation of blood can be helpful to prevent multiple donor exposure, cytomegalovirus infection, alloimmunization, and graft-versus-host rejection.
Key Words: Mechanical ventilation; Fluid restriction; Humidification; Leukocyte removal filter; Blood irradiation
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