Intraoperative Liberal versus Goal-directed Fluid Therapy in Neonates undergoing Laparotomy- A Prospective Randomized Controlled Trial

Intraoperative fluid therapy is an important aspect of perioperative care in neonates undergoing laparotomy, as maintaining adequate fluid balance is crucial for optimal outcomes.

-Liberal fluid therapy involves administering fluids more generously, often based on subjective clinical assessment and individual physician preferences. The aim is to ensure that the neonate has adequate circulating volume to maintain blood pressure and organ perfusion during surgery. This approach may involve administering fluids at a higher rate and/or larger volumes without strict adherence to specific hemodynamic targets. Advantages of liberal fluid therapy may include simplicity in application and rapid correction of hypovolemia if present. However, there are concerns associated with this approach. Excessive fluid administration can lead to fluid overload, which may result in edema, impaired organ function, and increased morbidity. Fluid overload can be particularly problematic in neonates, who have limited cardiovascular reserves.

-Goal-directed fluid therapy (GDFT) involves a more individualized and targeted approach to fluid administration. It aims to optimize hemodynamic parameters and tissue perfusion based on objective measures. GDFT involves continuous monitoring of specific parameters, such as central venous pressure (CVP), mean arterial pressure (MAP), cardiac output (CO), or stroke volume (SV), and plethysmograph variability index (PVI) to guide fluid administration. The goals typically focus on maintaining adequate cardiac output and oxygen delivery while avoiding fluid overload. Hemodynamic monitoring techniques such as arterial and central venous catheters, transesophageal Doppler, or non-invasive devices like PVI may be used to guide fluid therapy decisions. GDFT has been shown to be beneficial in various surgical settings, as it helps avoid both under- and over-resuscitation, optimizing fluid management and reducing complications.

The Pleth Variability Index (PVI), is a dynamic and non-invasive parameter, which can be utilized to administer GDFT. This study aims to compare the volume of fluids infused using PVI-based GDFT with the conventional method of fluid administration in neonates undergoing emergency laparotomy. The postoperative metabolic and hematological profile and clinical outcomes like bowel movement, anastomotic leak and the duration of hospital stay will also be compared.