Fluid supplementation for neonatal unconjugated hyperbilirubinaemia

Lai, Nai Ming; Kamar, Azanna Ahmad; Choo, Yao Mun; Kong, Juin Yee; Ngim, Chin Fang

doi:10.1002/14651858.cd011891

Cited by 5 publications

(6 citation statements)

References 59 publications

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“…acted as an arbiter for unresolved cases. We defined PIOs as outcomes that patients value directly [16, 21, 24, 25]. In the context of neonatal hyperbilirubinemia, this included major clinical events such as bilirubin encephalopathy or kernicterus or related clinical outcomes, collectively known as KSD.…”

Section: Methodsmentioning

confidence: 99%

“…A recent Cochrane review assessed the use of fluid supplementation on neonates with hyperbilirubinemia and showed that fluid supplementation appeared to reduce serum bilirubin in the first 12 h but made no clear difference thereafter. Remarkably, no infants in the intervention or the control group in all 7 included studies developed any bilirubin-associated neurological problems [21]. The finding exemplifies the problems in the use of surrogate markers such as serum bilirubin to represent outcomes that matter to patients, and in turn, highlights issues in the choice of population to evaluate these outcomes.…”

Section: Introductionmentioning

confidence: 99%

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The Choice of Population and Outcomes in Neonatal Trials on Hyperbilirubinemia: Are They Relevant? An Analysis of Cochrane Neonatal Reviews

et al. 2020

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Background: Neonates with jaundice are usually managed according to their serum bilirubin despite an unclear overall correlation between bilirubin levels and patient-important outcomes (PIOs) such as kernicterus spectrum disorder (KSD). Objectives: We examined data from Cochrane Neonatal reviews to assess whether conditions that constituted KSD were included as key outcomes and how commonly they occurred in the population studied. Methods: We identified Cochrane reviews, published till November 2017 that evaluated interventions for neonatal jaundice (NNJ). We extracted the following information at the review and study levels: included population, outcomes assessed (in particular, whether PIOs such as KSD were listed as the primary outcomes), as well as their cumulative incidence in the reviews. Results: Out of 311 reviews, 11 evaluated interventions for NNJ with 78 randomized controlled trials (RCTs) included. Among the reviews, a total number of 148 outcomes were predefined and 30 (20.3%) were PIOs related to KSD, with 11 (36.7%) listed as primary outcomes. Among the 78 included RCTs (total participants = 8,232), 38 (48.7%) enrolled predominantly high-risk and 40 (51.3%) enrolled predominantly low-risk population. A total number of 431 outcomes were reported, and 40 (9.2%) were PIOs related to KSD (of which 37 were from studies with high-risk infants), with 13 (32.5%) listed as primary outcome. Cumulatively, no infant developed KSD across all studies. Conclusions: There is suboptimal representation of PIOs such as KSD in neonatal trials and Cochrane reviews on NNJ. Over half of the trials included populations with very low risk of KSD, which does not represent judicious use of resources. Amidst our continued search for a more reliable surrogate marker for NNJ, studies should evaluate the whole spectrum KSD alongside serum bilirubin in high-risk populations with sufficiently significant event rates, as this will make the trial methodologically feasible, with findings that will impact the population concerned.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Choice of Population and Outcomes in Neonatal Trials on Hyperbilirubinemia: Are They Relevant? An Analysis of Cochrane Neonatal Reviews

et al. 2020

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“…Undoubtedly, the most notable breakthroughs in the field of cerebral palsy research in the last decade have been made in the area of prevention [9••, 10, 11••, [12][13][14][15][16][17][18]. The rate of cerebral palsy has fallen by 30% in some high-income countries, bringing the prevalence down to 1.4 per 1000 [1,2].…”

Section: Prevention Of Cerebral Palsymentioning

confidence: 99%

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

Novak

Morgan

Fahey

et al. 2020

Curr Neurol Neurosci Rep

669

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Purpose of Review Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening. We conducted a systematic overview of best available evidence (2012-2019), appraising evidence using GRADE and the Evidence Alert Traffic Light System and then aggregated the new findings with our previous 2013 findings. This article summarizes the best available evidence interventions for preventing and managing cerebral palsy in 2019. Recent Findings Effective prevention strategies include antenatal corticosteroids, magnesium sulfate, caffeine, and neonatal hypothermia. Effective allied health interventions include acceptance and commitment therapy, action observations, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor, oral sensorimotor plus electrical stimulation, pressure care, stepping stones triple P, strength training, task-specific training, treadmill training, partial body weight support treadmill training, and weight-bearing. Effective medical and surgical interventions include anti-convulsants, bisphosphonates, botulinum toxin, botulinum toxin plus occupational therapy, botulinum toxin plus casting, diazepam, dentistry, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy, and umbilical cord blood cell therapy. Summary We have provided guidance about what works and what does not to inform decision-making, and highlighted areas for more research.

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“…Still, there is no evidence that IVFs provide additional benefit beyond adequate oral hydration. 15 A Cochrane Review showed no evidence that IVFs administration alters clinical outcomes of bilirubin encephalopathy in otherwise healthy term infants requiring phototherapy due to unconjugated hyperbilirubinemia. 15 However, additional studies are needed to assess the role of IVFs in HDN.…”

Section: Acute Managementmentioning

confidence: 99%