Isotonic versus hypotonic fluid supplementation in term neonates with severe hyperbilirubinemia - a double-blind, randomized, controlled trial.

Abstract

AIM:

To compare the incidence of hyponatremia in full-term neonates with severe hyperbilirubinemia, receiving intravenous fluid supplementation with 0.2% saline in 5% dextrose versus 0.9% saline in 5% dextrose, to prevent blood exchange transfusion (BET).

METHODS:

In this double-blind, randomized, controlled trial, full-term newborns (≥37 weeks), appropriate for gestational age, with severe non-haemolytic hyperbilirubinemia (serum bilirubin ≥ 20 mg/dL) were enrolled. Eligible neonates were randomized to receive either 0.2% saline in 5% dextrose (hypotonic fluid group) or 0.9% saline in 5% dextrose (isotonic fluid group) over 8 hrs, in addition to phototherapy. The primary outcome was proportion of neonates developing hyponatremia (serum Na < 135 mmol/L) after 8 h.

RESULTS:

Forty-two neonates were analysed in each group. Proportion of neonates developing hyponatremia after 8 h was higher in hypotonic fluid group as compared to isotonic fluid group (48.8% vs. 10.5%, p < 0.001). However, a larger proportion in isotonic fluid group developed hypernatremia (39.5% vs. 12.2%, p < 0.001). The rate of BET was similar in both groups.

CONCLUSION:

In full-term neonates with severe hyperbilirubinemia, administration of hypotonic fluid to prevent BET was associated with a higher incidence of hyponatremia while isotonic fluid was associated with an increased incidence of hypernatremia.

• Authors: Karthik Balasubramanian, Praveen Kumar, Shiv Sajan Saini, Savita Verma Attri, Sourabh Dutta
• Journal: Acta paediatrica (Oslo, Norway : 1992) (Acta Paediatr) Vol. 101 Issue 3 Pg. 236-41 (Mar 2012) ISSN: 1651-2227 [Electronic] Norway
• PMID: 22040311 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
• Copyright: © 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.

Chemical References

• Hypotonic Solutions
• Isotonic Solutions
• Sodium Chloride
• Glucose

Topics

• Combined Modality Therapy
• Double-Blind Method
• Drug Administration Schedule
• Exchange Transfusion, Whole Blood
• Female
• Fluid Therapy (adverse effects, methods)
• Glucose (therapeutic use)
• Humans
• Hyperbilirubinemia, Neonatal (complications, therapy)
• Hypernatremia (epidemiology, etiology, prevention & control)
• Hyponatremia (epidemiology, etiology, prevention & control)
• Hypotonic Solutions
• Incidence
• Infant, Newborn
• Isotonic Solutions
• Kaplan-Meier Estimate
• Logistic Models
• Male
• Phototherapy
• Risk Factors
• Sodium Chloride (therapeutic use)
• Treatment Outcome