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Effect of intravenous fluid supplementation on exchange transfusion rate in neonatal unconjugated hyperbilirubinemia.

Pradeep Debata*, Arun Kumar Meena, Anita Yadav, Pratima Anand, Mehak Garg

Background: Severe hyperbilirubinemia has the potential to cause permanent neurological sequelae and long-term morbidity. Fluid supplementation along with intensive phototherapy has been shown to expedite decline in serum bilirubin in non-hemolytic unconjugated hyperbilirubinemia. Objective: Objective of this prospective cohort study was to evaluate the effect of fluid supplementation in addition to intensive phototherapy in neonates with all cause (haemolytic and nonhaemolytic) unconjugated hyperbilirubinemia. Methods: Neonates born at gestation greater than 35 weeks awaiting exchange transfusion were enrolled and administered fluid supplementation (50 ml/Kg of 5% dextrose N/5 solution along with half of the maintenance fluid) for 8 hours, in continuation with intensive phototherapy. Primary outcome was the need for exchange transfusion and secondary outcomes were rate of decline of serum bilirubin. Results: Exchange transfusion procedure could be averted in 76% (61/80) of enrolled neonates. Baseline total serum bilirubin cut off of 27.5 mg/dl was the only factor that predicted exchange transfusion with 89.47% sensitivity and 88.52% specificity and a negative predictive value of 96.4%. Conclusion: In neonates born at greater than 35 weeks gestation with unconjugated hyperbilirubinemia awaiting exchange transfusion, the delay in procedure due to logistic reasons in resource limited settings, can be utilized with fluid supplementation along with phototherapy to curtail the need for exchange transfusion.