Fluid supplementation for neonatal unconjugated hyperbilirubinaemia

Abstract

There is no evidence that IV fluid supplementation affects important clinical outcomes such as bilirubin encephalopathy, kernicterus, or cerebral palsy in healthy, term newborn infants with unconjugated hyperbilirubinaemia requiring phototherapy. In this review, no infant developed these bilirubin-associated clinical complications. Low- to moderate-quality evidence shows that there are differences in total serum bilirubin levels between fluid-supplemented and control groups at some time points but not at others, the clinical significance of which is uncertain. There is no evidence of a difference between the effectiveness of IV and oral fluid supplementations in reducing serum bilirubin. Similarly, no infant developed adverse events or complications from fluid supplementation such as vomiting or abdominal distension. This suggests a need for future research to focus on different population groups with possibly higher baseline risks of bilirubin-related neurological complications, such as preterm or low birthweight infants, infants with haemolytic hyperbilirubinaemia, as well as infants with dehydration for comparison of different fluid supplementation regimen.

Neonatal hyperbilirubinaemia: a global perspective

“…99 Evidence to support the use of clofibrate in combination with phototherapy 100 and fluid supplementation for infants who require phototherapy are inconclusive. 101 In recent years intravenous immune globulin (IVIG) has, in some settings, been shown to significantly reduce the need for exchange transfusion in infants with Rhesus or ABO incompatibility. 25,101 Of note, Huizing et al used IVIG strictly as a rescue therapy for infants who had crossed, or were about to cross, the intervention limits for exchange transfusion.…”

“…101 In recent years intravenous immune globulin (IVIG) has, in some settings, been shown to significantly reduce the need for exchange transfusion in infants with Rhesus or ABO incompatibility. 25,101 Of note, Huizing et al used IVIG strictly as a rescue therapy for infants who had crossed, or were about to cross, the intervention limits for exchange transfusion. 102 As most infants with blood group isoimmunisation can be managed very well with phototherapy only, using IVIG for all infants with blood group isoimmunisation will be wastefully expensive or even lead to a misconception about the utility of IVIG.…”

Maternity ward staff perceptions of exclusive breastfeeding in Finnish maternity hospitals: A cross-sectional study

“…Several potential events during postnatal hospitalization may pose barriers to EBF: 1) infant appearing hungry after breastfeeding 25 , 2) infant admission to the neonatal intensive care unit (NICU) 26 , 3) low infant birth weight 27 , 4) birth by caesarean section 28 , 5) insufficient milk supply, 6) mother's pain and discomfort 29 , 7) nipple and breast problems 30 , and 8) breastfeeding combined with supplemental feeding of formula 31 . During present-day hospitalizations, infants undergo many blood tests to measure blood glucose 32 , quantify bilirubin 33 and/or detect infection 34 . These tests are crucial to improving infant health, but often lead to increased frequency of supplemental feedings.…”

Variation in Care and Clinical Outcomes Among Infants Hospitalized With Hyperbilirubinemia

“…In addition, no associations between IVF use and duration of phototherapy or exchange transfusion could be determined. 19 Consequently, differences in interpretation of available evidence by clinicians and differences in provider experiences and biases may drive variation in IVF use among hospitals and highlight the need to identify which infants would benefit most from supplemental fluid administration.…”