Fluid Administration In Neonates With Hyperbilirubinemia - Randomised Controlled Trial

Abstract

Background : Hyperbilirubinemia is a common neonatal problem occurring in 60% term and 80% preterm neonates. This is due to increased breakdown of red blood cells and decreased clearance of bilirubin, which in turn is due to immaturity of the conjugation process in the liver and increased enterohepatic circulation. There is an indirect evidence of subclinical dehydration in large proportion of neonates with “idiopathic” hyperbilirubinemia. Majority of neonates are exclusively breast fed and due to increased sodium content especially in primiparous mothers and poor sucking by a low birth weight baby can cause dehydration. Various studies have shown that fluid supplementation can decrease total serum bilirubin levels more rapidly and decreases the need for exchange transfusion. Extra fluid administration can decrease enterohepatic circulation, dilute the serum bilirubin and increase renal excretion of water soluble photo isomers in urine. Further inadequate oral feeding in sleepy neonates due to significant hyperbilirubinemia along with insensible water loss during phototherapy can predispose to worsening of hyperbilirubinemia in new borns not receiving extra fluids Objective To evaluate the efficacy of oral fluid (ORS in double dilution) supplementation in accelerating the decline of serum bilirubin with intensive phototherapy among healthy term and late preterm neonates with hyperbilirubinemia.