Abstract
Objective
To analyze the factors responsible for failure of fluid supplementation in full-term neonates with severe non-hemolytic hyperbilirubinemia.
Methods
The data from two previous randomized controlled trials was used in this study. Full-term (≥37 wks) neonates with severe hyperbilirubinemia (serum total bilirubin 18–25 mg/dL), who received intravenous fluid supplementation in addition to phototherapy were included. Intravenous fluid supplementation was given for 8 h. Those neonates, whose serum bilirubin levels increased by 2 mg/dL or crossed 22 mg/dL, underwent exchange transfusion. The authors compared baseline serum bilirubin, sodium, and osmolality and their changes during study period in neonates who required exchange transfusion (Non-responders) with those who didn’t (Responders).
Results
The data of 121 neonates was analyzed (non-responders = 17, responders = 104). Both the groups had similar weight loss since birth, baseline serum sodium and osmolality. Mean baseline serum bilirubin [22.5 (1.7) vs 21.6 (1.6) mg/dL, p = 0.04] and cesarean/ instrumental delivery (27.6% vs 20.2%, p = 0.02) were significantly higher in non-responders. With fluid supplementation, serum sodium and osmolality changed similarly in both the groups over 8 h. On multiple regression analysis, only cesarean/instrumental delivery [OR 3.9 (95% CI–1.2, 13.4)] retained independent significance.
Conclusions
Fluid supplementation for severe non-hemolytic hyperbilirubinemia is less likely to be successful in neonates born by cesarean/instrumental delivery as compared to normal vaginal delivery.
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Contributions
SSS; Extracted analyzed and summarized the data, did analysis, wrote the initial draft, PK; Conceived the idea, planned the study, reviewed the analysis, revised it critically for important intellectual content, final approval of the manuscript,KB; Recruited subjects and collected data in one trial, SM; Recruited subjects and collected data in second trial.
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Saini, S.S., Kumar, P., Balasubramanium, K. et al. Fluid Supplementation in Hyperbilirubinemia. Indian J Pediatr 78, 1096–1099 (2011). https://doi.org/10.1007/s12098-011-0394-0
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DOI: https://doi.org/10.1007/s12098-011-0394-0