Fluid supplementation in management of neonatal hyperbilirubinemia: a randomized controlled trial

Area of Science:

• Neonatal Medicine
• Pediatric Gastroenterology
• Clinical Research

Background:

• Neonatal hyperbilirubinemia is a common condition requiring timely management.
• Intensive phototherapy is a standard treatment for elevated serum bilirubin levels.
• The role of fluid supplementation in enhancing phototherapy efficacy is under investigation.

Purpose of the Study:

• To assess the impact of intravenous fluid (IVF) and oral rehydration solution (ORS) supplementation on reducing serum bilirubin levels in neonates undergoing intensive phototherapy.
• To compare the efficacy of IVF and ORS with standard therapy in managing severe hyperbilirubinemia.

Main Methods:

• An open-label randomized controlled trial was conducted involving healthy term and late preterm neonates with severe hyperbilirubinemia (serum total bilirubin ≥18 mg/dL).
• Participants were assigned to receive either intravenous fluids (50 mL/kg over 8 hours), oral rehydration solution (50 mL over 8 hours), or standard therapy.
• All groups received intensive phototherapy.

Main Results:

• Intravenous fluid supplementation led to a significantly greater decline in serum total bilirubin (STB) by 15.5% over 8 hours compared to ORS (9.1%) and control (8.0%) groups (p < .001).
• The IVF group showed a significantly greater percentage decline in STB compared to both ORS and control groups.
• No significant differences were observed in the duration of phototherapy or the proportion of neonates requiring exchange transfusion among the three groups.

Conclusions:

• Intravenous fluid supplementation can expedite the reduction of serum total bilirubin in the initial hours of intensive phototherapy for neonatal hyperbilirubinemia.
• Despite faster initial bilirubin decline, IVF and ORS supplementation did not alter the overall duration of phototherapy or the need for exchange transfusion when used with intensive phototherapy.