Research in Medicine

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Background: Previous studies have demonstrated the efficacy of intravenous immunoglobulin therapy (IVIG) in decreasing the severity of neonatal immune hemolytic jaundice, the need for exchange transfusion, duration of phototherapy and hospital stay. Materials and methods: A randomized clinical trial was conducted in Taleghani Hospital in Tehran, between April 2003 and May 2004. Eighty full term infants with ABO or RH incompatibility and hyperbilirubinemia within the first 24 hours of life, were randomly assigned in two equal groups of experiment and control. A single dose of IV immunoglobulin 1g/kg was administered to 40 neonates over 4-6 hours during the first 24 hours of life along with phototherapy. 40 neonates in the control group received phototherapy alone. All patients were closely evaluated with respect to their general status, severity of jaundice, need for transfusion, and IVIG complications. T test and chi-square were used for data analysis. Results: The IVIG–treated neonates had a smaller rise in their bilirubin levels, required significantly less phototherapy (91 hours vs. 141 hours, p=0.0001), a shorter duration of hospitalization, (p=0.0001), and fewer exchange transfusions, (p<0.05), than those in the control group. We found no IVIG-related side effects. Conclusion: IVIG administration in newborns with ABO or RH hemolytic jaundice reduces the need for exchange transfusion, duration of phototherapy and hospital stay. However, further studies are required to determine the optimal dose and the frequency of infusions.

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Background: Jaundice is one of the most common problems in the neonatal period usual management of neonatal jaundice includes phototherapy, drug therapy, and exchange transfusion. In some countries, people use herbs for the treatment of jaundice. In Iran, cotoneaster spp. named shir khesht is used as a remedy for jaundice. Materials and methods: We prepared a 16% solution of shir khesht from the original plant. After controlling for contamination with pathogenic bacteria, the mixture, (5 gram of shir khesht in 30 ml. of distilled water), was given in three divided doses to 32 icteric newborns, for one day. 30 ml. of placebo mixture in three divided dose was given to 32 controls. Both groups received phototherapy as well. Serum bilirubin was checked prior to, and after prescription in each group every 12 hr for 36 hours. Results: Decline in the level of bilirubin in cases, i.e. those receiving shir khesht, was greater in comparison with controls reduction was significant at 12 hours, (mean=11.89±1.34 vs, 13.96±2.8), p=0.001, 24 hours, (mean=8.34±3.19 vs 11.66±2.33), p<0.001, and at 36hours (mean=3.90±2.48 vs 10.26±2.67) , p<0.001. The duration of hospital stay in cases was much less than controls, (mean admission in days=3.98 ±2 vs. 4.59±1.93, respectively), p<0.001. Conclusion: In this study shir khesht was found to be effective in the treatment of neonatal hyperbilirubinemia resulting in a rapid decline in serum bilirubin, thus reducing duration of hospital stay. We suggest that further studies should be done so that it could be dispensed as a standard formula and used for neonatal jaundice.

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Abstract: Background: Hyperbilirubinemia is a common problem in newborn infants and may progress to kernicterus if not treated. The objective of this study was to determine the therapeutic effect of clofibrate in full-term healthy neonates with non-hemolytic hyperbilirubinemia. Material and method: A randomized clinical trial was performed on two groups of healthy full-term neonates with jaundice. Clofibrate group, (n=50), received a single dose of oral clofibrate (100mg/kg), plus phototherapy, while the control group (n=50), received only phototherapy. Results: The mean plasma total bilirubin levels at 12, 24, and 48 hours after treatment were significantly lower in the clofibrate treated group, as compared with the control group (p=0.001). At 48 hours of treatment, 48% of patients in the clofibrate group, had bilirubin levels <12 mg/dl in comparison with 16% of control group (p=0.001). Treatment with clofibrate also resulted in a shorter duration of hospital stay as compared to the control group (p=0.001). Conclusion: A single oral dose of clofibrate (100mg/kg), along with phototherapy is more effective than phototherapy alone in treatment of non-hemolytic hyperbilirubinemia in full-term healthy newborn infants. KEYWORDS: Neonatal jaundice, Clofibrate, Non-hemolytic hyperbillirubinemia, RCT.

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Background : Hyperbilirubinemia is a common and often benign problem in neonates.
Severe neonatal indirect hyperbilirubinemia associated with neurological developmental disabilities, including auditory, cognitive and motor disorders. Motor disorders include dystonia, athetosis that is consistent with lesions of core nuclei. The tone and coordination abnomality are signs of lesion in cerebellum. Hyperbilirubinemia and kertnicterus-induced hearing loss include hearing processing imparment and sensorineural hearing loss. The goal of this study was to determine the neurological developmental  outcome and kernicterus in children at ages 24-36 months who had severe neonatal hyperbilirubinemia.
Materials and Methods: In a longitudinal study, newborns  that admitted to hospital with severe neonatal indirect  hyperbilirubinemia were followed. In one year, 181 neonates were admited and treated for severe jaundice. At the age 24 to 36 months, 121 cases were followed and evaluated for kernicterus.
Results: In this study 121 patients were followed that 52 patients (43%) were girls and 69 (57%)  were boys. The age of newborns at admission was 4.14±1.27 days and their birth weight was 3102 ±559 grams. The mean values of billirubin was 21.29±4.21 mg/dl at the time of hospitalization. Twenty eight patients (19.83%) had underwent exchange transfusion in addition to intensive phototherapy, of which 8 neonates(6.61%) had evidence of ABO incompatibiliry. These 8 patients had received intravenous immunglobolin to prevent the need for second exchange transfusion. Among the followed patients,  3 infants (2.47%) had developmental delay and diagnosed as kernicterus, of which 2 neonates had exchange transfusion due to ABO incompatibility.
Conclusion: In this study, less than 3% of infants with severe neonatal hyperbilirubinemia developed  kernicterus. It is necessary to inform parents about neonatal jaundice and its complications. Severe jaundice should be taken serious in the first days of life because of risk for kernicterus. Severe neonatal hyperbilirubinemia, if not treated properly and quickly, can cause developmental delay.