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Lung ultrasound–guided fluid resuscitation in neonatal septic shock: A randomized controlled trial

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Abstract

This randomized controlled trial aimed to determine whether lung ultrasound–guided fluid resuscitation improves the clinical outcomes of neonates with septic shock. Seventy-two patients were randomly assigned to undergo treatment with lung ultrasound-guided fluid resuscitation (LUGFR), or with usual fluid resuscitation (Control) in the first 6 h since the start of the sepsis treatment. The primary study outcome was 14-day mortality after randomization. Fourteen-day mortalities in the two groups were not significantly different (LUGFR group, 13.89%; control group, 16.67%; p = 0.76; hazard ratio 0.81 [95% CI 0.27–2.50]). The LUGFR group experienced shorter length of neonatal intensive care unit (NICU) stays (21 vs. 26 days, p = 0.04) and hospital stays (32 vs. 39 days, p = 0.01), and less fluid was used in the first 6 h (77 vs. 106 mL/kg, p = 0.02). Further, our study found that ultrasound–guided fluid resuscitation can significantly reduce the incidence of acute kidney injury (25% vs. 47.2%, p = 0.05) and intracranial hemorrhage (grades I–II) within 72 h (13.9% vs. 36.1%, p = 0.03). However, no significant difference was found in the resolution of shock within 1 h or 6 h, use of mechanical ventilation or vasopressor support, time to achieve lactate level < 2 mmol/L, and the number of participants developing hepatomegaly in the first 6 h.

Conclusion: Lung ultrasound is a noninvasive and convenient tool for predicting fluid overload in neonatal septic shock. Fluid resuscitation guided by lung ultrasound can shorten the length of hospital and NICU stays, reduce the amount of fluid used in the first 6 h, and reduce the risk of acute kidney injury and intracranial hemorrhage.

Trial registration: Registered in Guangdong Second Provincial General Hospital: 2021-IIT-156-EK, date of registration: November 13, 2021. And ClinicalTrials.gov: NCT06144463 (retrospectively registered).

What is Known:

• Excessive fluid resuscitation in neonates with septic shock had worse outcomes.

What is New:

• Lung ultrasound should be routinely used to guide fluid resuscitation in neonatal septic shock.

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Data availability

All data generated or analyzed during this study are included in this article and its supplementary material files. Further enquiries can be directed to the corresponding author.

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Acknowledgements

The authors are grateful to all participants and indebted to the nursing and medical staff of the NICU.

Funding

This work was supported by Guangzhou Science and Technology Plan Project (No. 2060206) to Zhenyu Liang, and the Science Foundation of Guangdong Second Provincial General Hospital (No. TJGC-2022015) to Zhenyu Liang.

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Authors and Affiliations

  1. Department of Pediatrics, Guangdong Second Provincial General Hospital, 466 Newport Middle Road, Haizhu District, Guangzhou, 510317, Guangdong Province, China

    Dabin Huang, Chuming You, Lin Li, Qiong Meng & Zhenyu Liang

  2. Department of Pediatrics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Dabin Huang

  3. Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Dabin Huang

  4. Department of Emergency, Guangzhou Panyu Central Hospital, Guangzhou, China

    Xiaowei Mai

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Contributions

All authors contributed to data analysis, drafting or revising the manuscript, gave final approval of the version to be published, and agreed to be accountable for all aspects of this work. ZL, QM, and DH conceived and designed the study. CY, XM, and LL contributed to data acquisition. DH performed and/or contributed critically to all experiments and analyzed the data. All authors participated in the interpretation of the results and critically revised the manuscript for important intellectual content. The corresponding author attests that all listed authors meet the authorship criteria and that no others meeting the criteria have been omitted.

Corresponding authors

Correspondence to Qiong Meng or Zhenyu Liang.

Ethics declarations

Ethics approval and consent to participate

This trial has been registered in Guangdong Second Provincial General Hospital, registration number 2021-IIT-156-EK, date of registration November 13, 2021. And it is also registered in ClinicalTrials.gov: NCT06144463 (retrospectively registered). This single‑center study was approved by the ethics committee of Guangdong Second Provincial General Hospital (Ethical approval number: 2021-KZ-088-02). All procedures performed in this study involving human participants were part of routine clinical evaluations in accordance with the institutional ethical standards and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Competing interests

The authors declare that they have no competing interests.

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Communicated by Daniele De Luca

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Huang, D., You, C., Mai, X. et al. Lung ultrasound–guided fluid resuscitation in neonatal septic shock: A randomized controlled trial. Eur J Pediatr 183, 1255–1263 (2024). https://doi.org/10.1007/s00431-023-05371-9

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