UĞUR DEMİRSOY, BURÇİN NALBANTOĞLU, AYŞİN NALBANTOĞLU, Mustafa ÇAKAN, Aysu SAY

İNDİREK HİPERBİLİRUBİNEMİ NEDENİYLE FOTOTERAPİ ALAN SADECE ANNE SÜTÜ İLE BESLENEN TERM YENİDOĞANLARDA İNTRAVENÖZ SIVI DESTEĞİNİN BİLİRUBİN SEVİYESİ ÜZERİNE ETKİSİ

Amaç:Bu çalışmada fototerapi alan term yenidoğanlara intravenöz veya oral sıvı desteği verilerek serum bilirubin seviyelerinin düşüş oranları karşılaştırılmıştır. Materyal ve Metot:Zeynep Kamil Kadın Doğum ve Çocuk Eğitim ve Araştırma Hastanesi'nin (İstanbul, Türkiye) yenidoğan yoğun bakım ünitesinde 4 aylık bir süre içinde gerçekleştirilmiş randomize kontrollü bir çalışmadır. Elli sağlıklı term bebek, hiperbilirübinemi nedeniyle fototerapi alırken sadece anne sütü (n=25) veya hem anne sütü hem de intravenöz sıvı (n=25) alacak şekilde randomize edildi. Bulgular:Her iki grup arasında doğum ağırlığı, gestasyonel yaş, doğum şekli, hastaneye kabul yaşı, serum osmolalitesi, hematokrit ve retikülosit sayısı ortalamaları açısından anlamlı fark yoktu (p>0,05). Benzer şekilde, yenidoğan yoğun bakım ünitesine başvuru sırasında ve fototerapi başladıktan sonraki 4, 8, 12, 24 ve 48. saatlerde serum total bilirubin düzeyi ortalamaları her iki grup için karşılaştırıldığında anlamlı fark yoktu (p> 0,05). Fototerapi süresi ve hastanede kalış süresi ortalamaları karşılaştırıldığında iki grup arasında anlamlı fark yoktu (p>0,05). Sonuç:Elde ettiğimiz sonuçlara göre, dehidratasyonu olmayan sağlıklı yenidoğanlara intravenöz sıvı desteği verilmesi serum bilirubin düşüş oranı ve fototerapi süresi üzerinde etkili değildir. Bununla birlikte, oral yolun kullanılması, intravenöz kanül gereksinimi ve bunlara ilişkin komplikasyonlardan kaçınmayı sağladı. Fototerapi sırasında insensibl sıvı kaybı artacağından oral beslenme ile hidrasyonun korunması çok önemlidir.

Effect of Fluid Supplementation on Serum Bilirubin Level During Phototherapy of Exclusively Breastfed Term Infants with Hyperbilirubinemia

Aim:This study compared the rates of decrease in serum bilirubin levels in severely jaundiced healthy term infants given oral or intravenous fluid supplementation during phototherapy. Materials and Methods:A randomized controlled study was carried out in the neonatal intensive care unit of Zeynep Kamil Maternity and Children Training and Research Hospital (Istanbul, Turkey) over a 4-month period. Fifty healthy term infants with hyperbilirubinemia were randomized to receive either solely breastmilk (n=25) or both breastmilk and intravenous fluid (n=25) during phototherapy. Results:There were no significant differences (p>0.05) in the mean birth weight, mean gestastional age, modes of delivery, mean time of admission age, mean serum osmolality, and hematocrit and reticulocyte count between the two groups. Similarly, there was no significant difference (p>0.05) in the mean indirect serum bilirubin level at the time of admission to the neonatal intensive care unit and at 4, 8, 12, 24, and 48 hours after commencement of phototherapy between the two groups. There was no significant difference (p>0.05) in the mean duration of phototherapy or in the median duration of hospitalization between the twogroups. Conclusion:Based on our results, intravenous fluid support has no effect on the rate of decrease in serum bilirubin and decrease in duration of phototherapy in healthy term newborns with no dehydration. However, using the oral route avoided the need for intravenous cannula and their attendant complications. Insensible fluid loss is increased during phototherapy, so protection of hydration status with oral feeding is important fornewborns.

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