What is the role of Hyaluronidase in premature babies?

From the Guidelines

Hyaluronidase has a limited role in premature babies, primarily as an adjunct to facilitate subcutaneous fluid administration when intravenous access is challenging. The use of hyaluronidase in this context is based on its ability to temporarily break down hyaluronic acid in connective tissue, thereby enhancing the absorption of subcutaneously administered fluids 1.

Key Considerations

• The typical dose for such procedures is not explicitly mentioned in the provided evidence, but it is crucial to follow established guidelines for the use of hyaluronidase in pediatric patients.
• The procedure, known as subcutaneous hydration or hypodermoclysis, allows for the easier spread of fluids through tissues, which can be particularly beneficial in premature babies with difficult vascular access.
• Administration involves injecting hyaluronidase at the subcutaneous site, followed by fluid administration within a specified timeframe, with the effect lasting approximately 24-48 hours.
• Common administration sites include the thigh, abdomen, or back, with careful monitoring for signs of irritation, swelling, or infection being essential.

Safety and Efficacy

While the provided evidence does not directly address the use of hyaluronidase in premature babies, its application in facilitating subcutaneous fluid administration is considered safe when used appropriately, as it increases tissue permeability without causing significant damage to fragile tissues 1. However, it is essential to use hyaluronidase as a temporary measure until secure intravenous access can be established, given the potential risks and the limited duration of its effect.

Clinical Decision Making

In clinical practice, the decision to use hyaluronidase in premature babies should be made on a case-by-case basis, considering the individual patient's needs and the availability of alternative methods for fluid administration. Given the potential benefits and the need for careful patient monitoring, hyaluronidase can be a valuable adjunct in the management of premature infants with challenging vascular access.

From the Research

Role of Hyaluronidase in Premature Babies

• Hyaluronidase has been studied in the context of premature birth, particularly in relation to group B streptococcus (GBS) infection 2.
• The enzyme has been shown to play a role in ascending GBS infection, which can lead to preterm birth and fetal demise 2.
• In addition to its role in infection, hyaluronidase has been used to treat infiltration injuries in neonates, although its production was discontinued in 2001 3.
• Alternative treatments, such as DuoDerm Hydroactive gel, have been used to manage infiltration injuries in neonates 3.
• Hyaluronidase has also been implicated in fetal growth and development, with one study suggesting that it may play a role in the rapid growth of the developing fetus 4.
• Furthermore, hyaluronidase has been shown to promote neurological recovery after intraventricular hemorrhage in premature infants 5.
• The use of hyaluronidase to treat intravenous extravasations has also been implemented in pediatric populations, with evidence suggesting that it can decrease the severity of tissue damage and result in cost savings 6.

Mechanisms of Action

• Hyaluronidase has been shown to degrade hyaluronan, a major component of the extracellular matrix, which can regulate inflammation and promote oligodendrocyte maturation and myelination 5.
• The enzyme has also been shown to reduce CD44 and TLR4 expression, proinflammatory cytokine levels, and microglia infiltration, which can contribute to neurological recovery after intraventricular hemorrhage 5.

Clinical Applications

• Hyaluronidase may be used to prevent or treat ascending GBS infection in pregnant women, although further research is needed to fully understand its role in this context 2.
• The enzyme may also be used to treat infiltration injuries in neonates, although alternative treatments such as DuoDerm Hydroactive gel may also be effective 3.
• Hyaluronidase may have a role in promoting neurological recovery after intraventricular hemorrhage in premature infants, although further research is needed to fully understand its mechanisms of action and potential clinical applications 5.