Background This study aimed to assess the independent effects of intravenous (IV) fluid supplementation and different enteral feeding patterns on bilirubin elimination in healthy term neonates treated with intensive phototherapy for severe indirect hyperbilirubinemia. Materials and methods This single-center, retrospective cohort study included 271 healthy term newborns who received phototherapy for indirect hyperbilirubinemia between 2023 and 2025. The neonates were divided into two groups: those receiving enteral feeding alone ( n = 160) and those receiving IV fluid supplementation in addition to enteral feeding ( n = 111). Data were analyzed using multivariate linear regression supported by sensitivity analyses adjusting for additional maternal and neonatal confounders, to account for baseline clinical differences and potential indication bias. Results The IV fluid supplementation group had significantly higher baseline total serum bilirubin (TSB) levels and postnatal age than the enteral feeding-only group ( p 0.001). After adjustment for baseline clinical differences, IV fluid supplementation was not independently associated with the rate or the percentage of bilirubin decline ( p 0.05). In contrast, mixed feeding with formula supplementation in addition to breastfeeding and a high baseline TSB level were independently associated with faster bilirubin clearance ( p 0.001). Higher maternal age was independently associated with a greater percentage reduction in bilirubin levels ( p = 0.018). Conclusion In term neonates with severe indirect hyperbilirubinemia with no clinical evidence of dehydration, IV fluid supplementation appeared to provided no additional benefit in reducing bilirubin levels. Our findings suggest that enteral feeding patterns may have a greater influence on the response to phototherapy. Therefore, our findings suggest that routine IV fluid administration may not be necessary in the management of hyperbilirubinemia, and priority should be given to effective lactation support and enteral feeding. When breast milk intake is insufficient, formula supplementation should be considered as a temporary and supportive option to accelerate bilirubin elimination, however, due to the heterogeneity in feeding volumes, this effect should be interpreted cautiously.
Tobcu et al. (Wed,) studied this question.
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