Fluid in Neonatal Hyperbilirubinemia
Fluid in Neonatal Hyperbilirubinemia
Hyperbilirubinemia is a common neonatal problem. bilirubin is potentially toxic to central
 nervous system and can cause serious permanent complication called kernicterus, in which
 brain stem nuclei and basal ganglia are damaged,resulting in cerebral palsy.In
 Hyperbiliubinemia,rapid reduction of serum bilirubin level is of utmost importance.

 Two commonly used mode of therapy are phototherapy and exchange transfusion. Phototherapy has
 some side effects such as diarrhea, skin rash, dehydration, overheating, mother-baby bonding
 disruption.On the other hand, complication of exchange transfusion include infections,
 emboli,anemia,apnea and hypocalcemia.

 while IV fluid supplementationis postulated to decrease bilirubin concentration directly
 through a reduction of haemoconcentration, increasing enteral feed volume is proposed to
 decrease bilirubin concentration through reduced enterohepatic circulation via an increased
 gut peristalsis.
Bilirubin encephalopathy or kernicterus Unconjugated bilirubin is lipid soluble and therefore
 can cross the blood brain barrier .There it can deposit in areas of the brain, with a
 predilection for deposition in the basal ganglia, auditory pathways, and oculomotor nucleus.
 This deposition and accompanying damage result in the classical symptoms associated with
 kernicterus. Hypoxia, acidosis, prematurity, and genetic predispositions all increase the
 risk for kernicterus.In well term babies risk for kernicterus increases after bilirubin
 levels cross (20 mg/dL) and it is very high above (30 mg/dL). In preterm babies the threshold
 for damage from bilirubin could be as low as(20mg/dl). The risk increases with increasing
 serum levels of unconjugated bilirubin.

 Acute bilirubin encephalopathy presents as lethargy, high pitched cry, poor feeding, abnormal
 tone, opisthotonus, upgaze palsy and seizures. Aggressive treatment at this stage can reduce
 the damage caused. Chronic bilirubin encephalopathy leads to conditions like choreoathetoid
 cerebral palsy, high frequency hearing loss, dental dysplasias and oculomotor palsies.
Inclusion Criteria:

 1 -Ful term ,Body weight (≥2.5kg). 2- total serum bilirubin range(≥18mg/dl to≤25mg/dl).
 3-Non -haemolytic type of jaundice. 4-Ratio of conjugated bilirubin :unconjugated bilirubin
 is 1:5

 Exclusion Criteria:

 1 - Body weight ≤2.5kg. 2- Evidence of haemolysis. 3- Obvious features of dehydration. 4-
 Major congenital malformation . 5- Baby received already IV fluid for any reason. 6-
 Septicemia . 7-GIT functional or organic obstruction .