Effectiveness of saline solutions in surgical interventions in newborns

BACKGROUND: In recent years, neonatal surgery has been developing and improving, among other things, because of a deeper study of anesthesiological approaches and the introduction of acquired knowledge into the daily practice of an anesthesiologist-resuscitator. One of the basic factors that influence treatment outcomes in the future is a thorough study of infusion therapy methods in newborns, considering the anatomical and physiological characteristics of the neonatal period.

AIM: This study aimed to examine the electrolyte balance, acid–base state, and hemodynamic parameters in newborns, depending on the choice of basic infusion medium during surgery.

MATERIALS AND METHODS: A prospective study was conducted in 99 newborns. All children were given an infusion of saline solutions of 10 mL/kg/h during surgery. Groups I, II, and III were administered intraoperatively with isotonic Sterofundin, saline solution, and Ringer’s solution, respectively. A hypotonic sodium chloride solution of 0.45% was administered to 11 children. The indicators of the acid–base state and electrolyte composition of the venous blood, hemodynamic parameters, and need for perioperative inotropic support were evaluated.

RESULTS: A tendency to hyponatremia was detected in children who were infused with 0.45% sodium chloride hypotonic solution, which resulted in the abandonment of further recruitment of children in the group and the implementation of this study option. After surgery, the pH-compensated state was maintained in all three groups. Moreover, metabolic disorders in the form of a decrease in bicarbonates and ВE were recorded in all groups. Electrolyte disturbances were detected in all groups, whereas electrolyte balance was most often registered in group I. In groups II and III, common ionogram findings included a decrease in potassium and an increase in sodium, chlorine, and calcium levels. In the analysis of the hemodynamic parameters, no significant statistical difference was recorded during surgery when comparing the groups infused with different saline media.

CONCLUSIONS: In this study, no significant differences were found in the indicators of acid–base state and hemodynamic parameters when using different saline solutions as basic intraoperative infusion therapy in newborns. Regarding the electrolyte balance, the most common complications were hypokalemia, hypernatremia, and hyperchloremia in the 0% saline group.