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Intravenous fluid supplementation in management of severe unconjugated hyperbilirubinemia in preterm neonates-a
Aradhana1, Santosh Kumar Panda2, Pravati Jena1
1Department of Paediatrics, Kalinga Institute of Medical Sciences, KIIT DU, Bhubaneswar, Odisha, India.
Insights
Intravenous fluid supplementation significantly reduces total serum bilirubin (TSB) in preterm neonates with hyperbilirubinemia. This approach aids in rapid TSB decline without increasing phototherapy duration or adverse effects.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Clinical Research
Background:
- Extra fluid supplementation is recognized for aiding total serum bilirubin (TSB) reduction in late preterm and term neonates.
- Intravenous fluid supplementation shows potential for rapid TSB decline in preterm neonates (29-33+6 weeks gestation) and may aid in managing severe hyperbilirubinemia with intensive phototherapy.
Purpose of the Study:
- To evaluate the efficacy of intravenous fluid supplementation in reducing TSB levels in preterm neonates diagnosed with hyperbilirubinemia.
- To assess the impact of fluid supplementation on the duration of phototherapy and incidence of hyponatremia in this vulnerable population.
Main Methods:
- An open-label randomized control trial involving 72 preterm neonates (gestational age 29-33+6 weeks) with hyperbilirubinemia.
- Participants were randomized into a fluid supplementation (FS) group receiving intravenous fluids with phototherapy and a control group receiving phototherapy alone.
- TSB levels were measured at 6, 18, and 24 hours post-intervention; phototherapy duration and hyponatremia cases were also recorded.
Main Results:
- The FS group demonstrated significantly greater reductions in TSB levels at 6, 18, and 24 hours compared to the control group (P < 0.001 for all time points).
- Mean TSB reduction at 24 hours was 2.96 (1.41) mg/dl in the FS group versus 1.56 (0.46) mg/dl in the control group.
- No significant difference was observed in the duration of phototherapy (44.66 vs 43.33 hours) or the incidence of hyponatremia (40% vs 24.3%) between the groups.
Conclusions:
- Intravenous fluid supplementation is an effective strategy for accelerating TSB reduction in preterm neonates with severe hyperbilirubinemia.
- The intervention shows minimal adverse effects and does not prolong the duration of necessary phototherapy.
- Fluid supplementation can be considered a valuable adjunct in managing hyperbilirubinemia in this neonatal subgroup.
Abstract:
The purpose of this study is to evaluate the role of intravenous fluid supplementation in reducing total serum bilirubin (TSB) in preterm neonates with hyperbilirubinemia. In this open-label randomized control trial, a total of 72 preterm neonates with a gestational age of 29-33+6 weeks and a TSB level exceeding 2 mg/dl below the exchange transfusion threshold as per United Kingdom National Institute for Health and Care Excellence (UK-NICE) guidelines were randomized into the fluid supplementation (FS) group and the control group in a ratio of 1:1. Neonates in the FS group received intravenous fluid (5% dextrose on day 2 or N/5 saline with 5% dextrose, amount: 1/4th of total daily fluid intake or maximum 30 ml/kg over 8 h) with phototherapy vs. only phototherapy in the control group. The primary outcome was reduction in TSB level at 6, 18, and 24 h after intervention and duration of phototherapy in FS compared to the control group. The demographic characteristics and mean (SD) TSB levels of enrolled preterm neonates in both groups were comparable. The mean (SD) reduction in TSB level at 6 h in the FS group and the control group were 1.42 (1.19) and 0.32 (0.17), P = 0.001; at 18 h, 2.11 (1.35) and 0.79 (0.25), P = 0.001; and at 24 h, 2.96 (1.41) and 1.56 (0.46), P = 0.001. There was no significant difference in the duration of phototherapy [mean (SD) 44.66(5.45) vs 43.33 (5.93) h, P = 0.32] and cases of hyponatremia [14 (40%) vs 09 (24.3%) P = 0.153] at 24 h between FS and control group.
Conclusion:
Intravenous fluid supplementation helps in the rapid reduction of TSB levels in preterm neonates with severe hyperbilirubinemia with minimal adverse effects, but does not affect the duration of phototherapy.
What Is Known:
• Extra fluid supplementation has been found helpful in declining total serum bilirubin levels in late preterm and term neonates.
What Is New:
• Extra intravenous fluid supplementation may help in the rapid decline in total serum bilirubin in preterm neonates born with a gestational age of 29-33+6 weeks. • It may be used in the management of severe hyperbilirubinemia in preterm neonates with intensive phototherapy.
Trial Registration:
Clinical trials registry of India, number-CTRI/2024/01/061381 dated on 04.01.2024.
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