Preterm Neonates: Beyond the Guidelines for Neonatal Hyperbilirubinemia

The efficacy of intravenous fluid supplementation for neonatal hyperbilirubinemia: a meta-analysis of randomized controlled studies

Introduction: The efficacy of intravenous fluid supplementation for neonatal hyperbilirubinemia remains controversial. We conduct a systematic review and meta-analysis to explore the influence of intravenous fluid supplementation on treatment efficacy of neonatal hyperbilirubinemia.Methods: We search PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases through June 2019 for randomized controlled trials (RCTs) assessing the efficacy of intravenous fluid supplementation for neonatal hyperbilirubinemia. This meta-analysis is performed using the random-effect model.Results: Six RCTs are included in the meta-analysis. Overall, compared with control group for neonatal hyperbilirubinemia, intravenous fluid supplementation is associated with decreased TSB at 8 h (std. MD = -0.82; 95% CI = -1.46 to -0.17; p = .01), 12 h (std. MD = -0.46; 95% CI = -0.81 to -0.10; p = .01), 24 h (std. MD = -0.47; 95% CI = -0.78 to -0.16; p = .003) and 36 h (std. MD = -0.37; 95% CI = -0.73 to -0.02; p = .04), as well as reduced incidence of exchange transfusion (RR = 0.29; 95% CI = 0.14-0.59; p = .0006), but has no significant impact on duration of phototherapy (std. MD = -0.34; 95% CI = -0.88-0.21; p = .22).Conclusions: Intravenous fluid supplementation can provide additional benefits for the treatment of neonatal hyperbilirubinemia.

Use of a hand-held spectroradiometer for the measurement of neonatal phototherapy lamp outputs

The measurement capability of a hand-held spectroradiometer for validation of phototherapy light treatment for neonates is described. This function is compared with that of a double grating monochromator system with photomultiplier detector, where parameters evaluated included wavelength accuracy and accuracy of irradiance within set wavelength intervals - 460 nm to 490 nm and 400 nm to 550 nm. Measurements carried out in a clinical setting revealed that the hand-held spectroradiometer provided an acceptable level of accuracy for determining output characteristics of the phototherapy devices investigated. It was observed that measurement errors were more significant for studies involving direct contact with light emitting surfaces. It was identified that the spectral resolution of the MSC15 device could act to degrade the accuracy of the device where narrow spectrum peaks occurred around the limits of specific identified bandwidths - such as at 460 nm and 490 nm. This was identified not to be an issue with typical light emitting diode phototherapy systems, where the spectral outputs do not contain narrow spectral components. The device lends itself also to use by clinical staff in the clinical environment to verify the output of phototherapy lamps. The availability of such hand-held spectroradiometer devices represents an advance on the use of output meters suppled by equipment manufacturers.

The influence of massage on neonatal hyperbilirubinemia: a meta-analysis of randomized controlled trials

Introduction: The efficacy of massage to treat neonatal hyperbilirubinemia remains controversial. We conducted a systematic review and meta-analysis to explore the influence of massage on the neonatal hyperbilirubinemia. Methods: We search PubMed, Embase, Web of science, EBSCO, and Cochrane Library databases through November 2017 for randomized controlled trials (RCTs) assessing the effect of massage on neonatal hyperbilirubinemia. This meta-analysis is performed using the random-effect model. Results: Six RCTs involving 357 patients are included in the meta-analysis. Overall, compared with the control group in neonatal hyperbilirubinemia, massage therapy is associated with substantially reduced serum bilirubin level within 4 d (mean difference (MD) = -2.31; 95% CI = -2.92 to -1.70; p < .00001) and transcutaneous bilirubin level within 4 d for neonatal hyperbilirubinemia (MD = -1.97; 95% CI = -2.55 to -1.39; p < .00001), but results no remarkable impact on serum bilirubin level on 2 d (MD = -0.82; 95% CI = -2.16-0.52; p = .23), transcutaneous bilirubin level on 2 d (MD = -0.17; 95% CI = -1.34 to 1.00; p = .77), frequency of defecation daily on 2 d (MD = 0.57; 95% CI = -0.03 to 1.16; p = .06), and frequency of defecation daily within 4 d (MD = 0.83; 95% CI = -0.11 to 1.76; p = .08). Conclusions: Massage therapy can significantly reduce serum bilirubin level and transcutaneous bilirubin level within 4 d, but demonstrates no influence on serum bilirubin level and transcutaneous bilirubin level on 2 d, frequency of defecation daily on 2 and 4 d for neonatal hyperbilirubinemia.