Safety issue of hydroxyethyl starch on neonatal renal function

Objective: Hydroxyethyl starch (HES) is a synthetic fluid product commonly used in intensive and emergency care medicine. Controversy exists about its (side) effects on renal function. The aim was to test the impact of hydroxyethyl starch on the immature renal system of neonates in comparison to isotonic saline solution. Methods: In our retrospective analysis, 50 inborn neonates without known renal dysfunction suffering from severe hypovolemia were volume substituted according to neonatal standards. 25 neonates were treated with hydroxyethyl starch (4ml/kg hydroxyethyl starch 200/0.5) compared to 25 neonates treated with 10ml/kg 0.9% isotonic saline. Serum creatinine was measured before, directly after, 24 hours, 7 days and 14 days after volume substitution. At the same time points glomerular filtration rate and urinary output were detected. Results: Neither serum nor urinary renal function parameters were negatively influenced in neither group. Conclusion: A single volume shot of hydroxyethyl starch in neonates in hypovolemic state is an effective treatment in stabilizing cardiac output represented as arterial blood pressure and probably helps to reduce endothelial edema in septic shock by its beneficial effects on microcirculation that is described elsewhere. No adverse effects on renal function in our neonatal population occurred. The impact on renal function is comparable to that after the treatment with isotonic saline.

Glomerular filtration rate - Hydroxyethyl starch - Hypovolemia - Neonate - Shock