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

Objective: To evaluate the efficacy of oral or intravenous fluid supplementation in accelerating the decline of serum bilirubin with intensive phototherapy among healthy term and late preterm neonates with hyperbilirubinemia.Study design: This open-label randomized controlled trial randomized neonates with severe hyperbilirubinemia (serum total bilirubin 18mg/dL or within 2mg/dL of threshold for exchange transfusion) to receive 50mL/kg of intravenous fluid over 8h (IVF group, n=51), 50mL of oral rehydration solution over 8h (oral rehydration solution (ORS) group, n=50) or only standard therapy (control group, n=49). Intensive phototherapy was administered in all the three study groups.Result: Over 8h of intervention, serum bilirubin declined by 15.5% (95% CI: 11.7-19.4%) in IVF group, by 9.1% (95% CI: 7.3-10.9%) in ORS group and by 8.0% (95% CI: 6.2-9.7%) in control group (p<.001). Percent decline in serum bilirubin serum total bilirubin (STB) was significantly greater in IVF group as compared to ORS (mean difference: -6.4% 95% CI: -1.9 to -11.0) and control (mean difference: -7.6% 95% CI: -3.0 to -12.1) groups. Duration of phototherapy and proportion of neonates needing exchange transfusion were comparable in the three study groups.Conclusions: Intravenous fluid supplementation may result in a faster decline of STB in first few hours of treatment. However, with the use of intensive phototherapy, there was no effect on overall duration of phototherapy or need of exchange transfusion.Clinical Trial Registration: Clinical trial registry of India: REF/2015/09/009775