Randomized controlled trial of oral versus intravenous fluid supplementation on serum bilirubin level during phototherapy of term infants with severe hyperbilirubinaemia

Background Hyperbilirubinemia is the most common clinicalphenomenon found in newborns. Phototherapy is the standardtreatment for lowering bilirubin levels in neonates. Whileintensive (double) phototherapy produces a more rapid declinein serum bilirubin levels than standard (single) phototherapy,greater rebound effects may occur.Objective To assess bilirubin levels in neonates with hyperbilirubinemiawho underwent single or double phototherapy, includingrebound bilirubin levels after phototherapy termination.Methods An open, randomized, controlled trial was con ductedat H. Adam Malik Hospital and Dr. Pirngadi Hospital, Medan,from August 2009 until January 2010. Subjects with indirecthyperbilirubinemia were divided into two groups. One groupreceived single phototherapy (n = 41) and other receiveddouble photo therapy (n = 40) . Measurements of total plasmabilirubin level were conducted at 12 hours and at 24 hoursof phototherapy, as well as at 24 hours after phot otherapytermination. Rebound bilirubin serum level was defined asan increment of about 1 - 2 mg/dL serum bilirubin afterphototherapy discontinuation.Results The decreases in serum bilirubin levels were significantlygreater in the do uble phototherapy group for observationsat 12 h ours , 24 h ours, and 24 hours after phototherapyt ermination (P = 0.0001). At the 24-hour observation afterterminationofphototherapy, only 1 neonate (2.7%) in the singlephototherapy group compared to 4 neonates (10.8%) in thedouble phototherapy group had serum bilirubin level increasesof 1 - 2 mg/dL. Fisher's exact test did not reveal a significantdifference in rebound serum bilirubin occurrence in the twogroups (P = 0.358).Conclusion Double phototherapy shows significantly greaterdecrease in bilirubin level compared to single phototherapywithin a same period of time. Rebound serum bilirubin levels aftersingle and double phototherapy may occur in some patients withhyperbilirubinemia, as bilirubin production continues. However,260 • Paediatr Irulones, Vol. 54, No. 5, September 2014there is no significant difference in rebound effects between singlevs. double phototherapy.

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Effect of intravenous fluid supplementation on drop in serum bilirubin levels in term babies with severe hyperbilirubinemia

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20175568 ◽

2017 ◽

Vol 5 (1) ◽

pp. 106

Author(s):

Priyanka Tank ◽

Rakesh Tank ◽

Abhishek Singh

Keyword(s):

Bilirubin Level ◽

Serum Bilirubin ◽

Serum Bilirubin Level ◽

Intravenous Fluid ◽

Total Serum ◽

Control Group ◽

Study Group ◽

Breast Feed ◽

Fluid Supplementation ◽

Severe Hyperbilirubinemia

Background: Varied results emerging out of various studies have created a controversy about effect of intravenous fluid supplementation on drop in Serum Bilirubin levels in term babies with severe hyperbilirubinemia. Paucity of literature also warrants this study. The objective of this study is to evaluate the probable effect, if any, of intravenous fluid supplementation in decreasing the serum bilirubin level in healthy term babies with hyperbilirubinemia from Northern India.Methods: In this prospective study healthy term neonates (37-41 weeks gestation) with serum bilirubin (>18 mg/dl and <25 mg/dl) for treatment with phototherapy were randomly allocated to two groups, study group received intravenous fluid for total 16 hours along with breast feed and control group given only breast feeds. Results: Baseline variables like sex distribution, age at admission, gestation, birth weight, admission weight, number of babies, appropriate for gestational age, mode of delivery, oxytocin use, incidence of breast feeding and serum bilirubin level at the time of inclusion in study, were comparable in both control and study group. Drop of total serum Bilirubin (TSB) at 4 hours, 8 hours, 24 hours, 36 hours and 48 hours of study were also significantly higher in study group as compared to control group. Although the drop in TSB level at 60 hours between two groups was not significantly different. Conclusions: Based on our findings it can be concluded that additional intravenous fluid supplementation significantly reduced the serum bilirubin in study group as compared to control group.

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