Effect of Oral Zinc Sulfate Therapy on the Management of Neonatal Non-Hemolytic Unconjugated Hyperbi-lirubinemia: A Randomized Control Trial

Document Type : Original Article

Authors

Department of Pediatric, Faculty of Medicine, Ain Shams University, Cairo, Egypt

10.22038/ijn.2022.63062.2216

Abstract

Background: Zinc (Zn) salts have been tried for the prevention and treatment of neonatal jaundice as they are presumed to reduce serum bilirubin through the inhibition of enterohepatic circulation with controversial results. This study aimed to evaluate the effect of Zn sulfate on both bilirubin levels and the duration of phototherapy during the management of neonatal jaundice.
Methods: A double-blinded prospective study was conducted on 60 healthy neonates, ≥36 weeks gestation, with unconjugated non-hemolytic neonatal hyperbilirubinemia requiring phototherapy within the first week of life. They were divided into three groups of: A (n=20) receiving placebo, B (n=20) receiving low-dose oral Zn sulfate (10mg/day), and C (n=20) receiving high-dose oral Zn sulfate (20 mg/day), in combination with phototherapy for seven days. Serum bilirubin levels were measured on day 1 before starting the treatment and were reevaluated on days 3 and 7.
Results: Day 3 bilirubin was significantly lower in group C, compared to groups A and B (12.36±2.50 vs. 13.99±1.59 and 13.65±1.67 mg%; P<0.011 and P<0.043, respectively). Moreover, day-7 bilirubin demonstrated a significant decrease in group C than in group A (8.03±1.75 vs. 10.47±2.24 mg%, P<0.001). Total phototherapy duration was significantly shorter in group C, compared to groups A and B (26.05±11.42 vs. 37.70±18.27 and 36.90±12.47 h; P<0.032 and P<0.028, respectively).
Conclusion: The administration of oral Zn sulfate in a dose of 20 mg/day in combination with phototherapy could be helpful and safe in reducing both bilirubin level and phototherapy duration in jaundiced neonates.
 
 

Keywords


  1. Bhutani VK, Zipursky A, Blencowe H, Khanna R, Sgro M, Ebbesen F, et al. Neonatal hyperbilirubinemia and rhesus disease of the newborn: incidence and impairment estimates for 2010 at regional and global levels. Pediatr Res.2013; 74(1):86-100.
  2. Yang L, Wu D, Wang B, Bu X, Tang J. Theinfluence of zinc sulfate on neonatal jaundice: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2018; 31(10):1311-
  3. Mohammadzadeh A, Farhat AS, Alizadeh Kaseb A, Khorakian F, Ramezani M. Prophylactic effect of zinc sulphate on hyperbilirubinemia in premature very low birth weight neonates: a randomized clinical trial. Iran J Neonatol.2015; 5(4):6-10.
  4. Armanian AM, Barekatain B, Hoseinzadeh M, Salehimehr N. Prebiotics for the management of hyperbilirubinemia in preterm neonates. J Matern Fetal Neonatal Med. 2016: 29(18);3009-13.
  5. Dennery PA. Pharmacological interventions for the treatment of neonatal jaundice. Semin Neonatol. 2002; 7(2):111-9. J Perinatol. 2016;36(2):132-6.
  6. Ramy N, Ghany EA, Alsharany W, Nada A, Darwish RK, Rabie WA, Aly H. Jaundice, phototherapy and DNA damage in full-term neonates.J Perinatol. 2016;36(2):132-6.
  7. Wedekind KJ, Hortin AE, Baker DH. Methodology for assessing zinc bioavailability: efficacy estimates for zinc methionine, zinc sulfate, and zinc oxide. J Anim Sci. 1992; 70(1):178-87.
  8. Strand TA, Chandyo RK, Bahl R, Sharma PR, Adhikari RK, Bhandari N, et al. Effectiveness and efficacy of zinc for the treatment of acute diarrhea in young children. Pediatrics. 2000; 109(5):898-903.
  9. Ali SR, Abdel-aal M, Elsamanoudy M, Ibrahim S. Serum zinc level in neonates with indirect hyperbilirubinemia. Int J Med Arts. 2020; 2(1):217-22.
  10. Rana N, Mishra S, Bhatnagar S, Paul V, Deorari AK, Agarwal R. Efficacy of zinc in reducing hyperbilirubinemia among at-risk neonates: a randomized, double-blind, placebo-controlled trial. Indian J Pediatr. 2011; 78(9):1073-8.
  11. Patton P, Rachmadi D, Sukadi A. Effect of oral zinc on hyperbilirubinemia in full term neonates. Paediatr 2011; 51(2):107-10.
  12. Maamouri G, Boskabadi H, Mafinejad S, Bozorgnia Y, Khakshur A. Efficacy of oral zinc sulfate intake in prevention of neonatal jaundice. Iran J Neonatol. 2014; 4(4):11-6.
  13. Kumar A, Bagri NK, Basu S, Asthana RK. Zinc supplementation for neonatal hyperbilirubinemia: a randomized controlled trial. Indian Pediatr. 2014; 51(5):375-8.
  14. Hashemian S, Mohammadzadeh A, Ataee Nakhaei A. Efficacy of zinc sulfate in reducing unconjugated hyperbilirubinemia in neonates. Clin Med Rev. 2014; 1(4):229-32.
  15. Ahmadpour kacho M, Zahed Pasha Y, Ranjbar B, Pouramir M, Hajian Tilaki K, Pournasrollah M. The effect of oral zinc sulfate on serum bilirubine level in term neonates with jaundice. Int J Pediatr. 2017; 5(6):5053-60.
  16. Beiranvand S, Hosseinabadi R, Firouzi M, Almasian M, Anbari K. Impact of combined oral zinc sulfate and phototherapy on serum bilirubin levels in the term neonates with jaundice. Iran J Neonatol. 2018; 9(3):20-5.
  17. Khoshhevisasl P, Sadeghzadeh M, Kamali K, Moeinian M. Effect of zinc on hyperbilirubinemia of newborns, a randomized double blinded clinical trial. Curr Health Sci J. 2020; 46(3):250-4.
  18. Agrawal K, Kumar S, Sethi RS. Efficacy of oral zinc acetate in reducing hyperbilirubinemia in full-term and near-term high risk neonates. J Med Dent Sci. 2018; 17(2):1-5.
  19. Eldesoky MEI, El Samannody MI, Elghannam MZ, Elmazahy MM. Effect of zinc supplementation on serum bilirubin level in term neonates undergoing phototherapy. Int J Med Arts. 2020; 2(4):736-40.
  20. Faal G, Masjedi HK, Sharifzadeh G, Kiani Z. Efficacy of zinc sulfate on indirect hyperbilirubinemia in premature infants admitted to neonatal intensive care unit: a double-blind, randomized clinical trial. BMC Pediatrics. 2020; 20(1):1-7.
  21. Engorn B, Flerlage J. The Harriet lane handbook E-book. 20th edition. Philadelphia: Elsevier Inc; 2014.
  22. Babaei H, Hemmati M, Fallahi V, Rezaei M. Effect of oral zinc sulfate in prevention of jaundice in healthy term newborns. J Kermanshah Univ Med Sci. 2014; 17(11):680-6.