title: Isotonic versus hypotonic fluid supplementation in term neonates with severe hyperbilirubinemia - a double-blind, randomized, controlled trial.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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: Department of Pediatrics, Neonatal unit, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors: Karthik
authors: K
authors: Balasubramanian
authors: Praveen
authors: P
authors: Kumar
authors: Shiv Sajan
authors: SS
authors: Saini
authors: Savita Verma
authors: SV
authors: Attri
authors: Sourabh
authors: S
authors: Dutta
mesh_terms: D003131:Combined Modality Therapy; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005078:Exchange Transfusion, Whole Blood; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D005947:Glucose / Q000627:therapeutic use*; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000150:complications / Q000628:therapy*; D006955:Hypernatremia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D007010:Hyponatremia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D007038:Hypotonic Solutions; D015994:Incidence; D007231:Infant, Newborn; D007552:Isotonic Solutions; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D010789:Phototherapy; D012307:Risk Factors; D012965:Sodium Chloride / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D007038:Hypotonic Solutions; D007552:Isotonic Solutions; D012965:Sodium Chloride; D005947:Glucose