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Intravenous Fluid Supplementation for Preterm Infants With Hyperbilirubinemia: A Retrospective Cohort Study
Heidi Al-Wassia1, Shadi Garrada
1Department of Pediatrics, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Ms Al-Wassia); and Department of Pediatrics, King Fahad Specialist Hospital, Dammam, Saudi Arabia (Mr Garrada).
Insights
Fluid supplementation in preterm infants with jaundice (high bilirubin) speeds up bilirubin reduction and shortens phototherapy duration. This method is safe, showing no increase in prematurity-related complications.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Perinatology
Background:
- Neonatal hyperbilirubinemia is a common issue, with phototherapy as the standard treatment.
- Fluid supplementation is a potential strategy to lower serum bilirubin levels in newborns.
Purpose of the Study:
- To evaluate the safety and efficacy of fluid supplementation versus standard fluid management in preterm infants with unconjugated hyperbilirubinemia undergoing phototherapy.
Main Methods:
- A retrospective cohort study included preterm infants (28-32 weeks gestation) requiring phototherapy within the first week of life.
- Data were collected from infants admitted to a neonatal intensive care unit in Jeddah, Saudi Arabia, during 2017.
Main Results:
- Infants receiving fluid supplementation showed a significantly greater daily decline in total serum bilirubin and a shorter phototherapy duration.
- No significant differences were observed in weight or sodium changes, or the need for exchange transfusion.
- Prematurity-related in-hospital morbidities were comparable between the fluid supplementation and standard fluid management groups.
Conclusions:
- Fluid supplementation in preterm infants undergoing phototherapy accelerates bilirubin reduction and reduces treatment duration without adverse effects on prematurity-related morbidities.
- Further randomized controlled trials are recommended to confirm the benefits and risks of fluid supplementation in this population.
Background:
Hyperbilirubinemia is one of the most frequently occurring problems in the neonatal period, and phototherapy has remained the primary treatment of choice. Fluid supplementation has been proposed to reduce serum bilirubin levels.
Purpose:
To assess the risks and benefits of fluid supplementation compared with standard fluid management in preterm infants with unconjugated hyperbilirubinemia under conventional phototherapy.
Methods:
A retrospective cohort study of preterm infants (gestational ages ≥28 to ≤32 weeks) admitted to the neonatal intensive care unit at the Maternity and Children Hospital in Jeddah, Saudi Arabia, from January 1, 2017, to December 31, 2017, and required the initiation of phototherapy in the first week of life.
Results:
One hundred and fifteen infants were included; 51 received fluid supplementation, and 64 received standard fluid management. There were no significant differences in demographic characteristics between groups. The infants who received fluid supplementation had a significantly larger decline in the total serum bilirubin level per day and a shorter phototherapy duration ( P < .01). There were no significant differences in weight ( P = .14), or sodium ( P = .79) change per day or the need for exchange transfusion between groups. The prematurity-related inhospital morbidities were similar between groups.
Implications For Practice And Research:
Fluid supplementation in preterm infants receiving conventional phototherapy resulted in a faster decline in the bilirubin level and a shorter duration of phototherapy, without increasing prematurity-related morbidities. Future randomized controlled trials to assess the benefits and risks of fluid supplementation during conventional phototherapy in preterm infants are needed.
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