Effect of oral zinc on hyperbilirubinemia in full term neonates

Patton Patton; Dedi Rachmadi; Abdurachman Sukadi

doi:10.14238/pi51.2.2011.107-10

Patton Patton Depattment of Child Health, Universitas Padjadjaran Medical School/Dr. Hasan Sadikin Hospital, Bandung, West Java
Dedi Rachmadi Depattment of Child Health, Universitas Padjadjaran Medical School/Dr. Hasan Sadikin Hospital, Bandung, West Java
Abdurachman Sukadi Depattment of Child Health, Universitas Padjadjaran Medical School/Dr. Hasan Sadikin Hospital, Bandung, West Java

DOI: https://doi.org/10.14238/pi51.2.2011.107-10

Keywords: full term neonates, hyperbilirubinemia, oral zinc, survival analysis

Abstract

Background Oral zinc has been shown to reduce serum unconjugated bilirubin in animals, adolescents and low birth weight neonates. However, studies in healthy tenn neonates given oral zinc showed no reduction in hyperbilirubinemia based on time measurement in days. In order to improve accuracy, hyperbilirubinemia may be determined based on time measurements in hours.

Objective To determine the effect of oral zinc on hyperbiliru-binemia in full term neonates, based on time measurement in hours, rather than days.

Methods We conducted a randomized, double-blind clinical trial on healthy term neonates born spontaneously or through elective caesarean section in Hasan Sadikin Hospital from June to July 2010. Subjects were randomized into two groups: those receiving 5 mg of zinc sulphate and those receiving a placebo, sucrose, each twice daily. Serum total bilirubin level was examined at discharge and upon followô€‚up at day 5 of life. Factors which may be related to hyperbilirubinemia such as maternal age, infants' gender, umbilical cord bilirubin levels and type of feeding, were analyzed by Chi-square test. Hyperbilirubinemia persistence and comparison of survival distributions were analyzed by Kaplan-Meier survival analysis and Logrank test.

Results Out of 60 subjects, 26 had hyperbilirubinemia. The mean duration of hyperbilirubinemia in the 15 subjects in the zinc group and 11 in the placebo group were 116.5 hours and 117.3 hours, respectively. There was no significant difference in hyperbilirubinemia duration between the two groups ( P=0.496, 95% CI 111.5 to 122.7). In addition, Chi-square analysis of factors which may be related to hyperbilirubinemia showed no significant difference between the two groups (P > 0.05).

Conclusions Oral zinc 5 mg tMce daily made no significant difference in hyperbilirubinemia duration in full tenn neonates despite measuring in hours.

References

1. Wong RJ, D e Sandre GH, Sibley E, Stevenson DK. Neonatal jaundice and liver disease. In: Martin RJ, Fanaroff AA, Walsh MC, editors. Fanaroff & Martin's neonatal-perinatal medicine. 8th ed. Philadelphia: Mosby Elsevier; 2006. p. 1419-61.
2. Martin CR, Cloherty JP. Neonatal hyperbilirubinemia. In: Cloherty JP, Eichenwaald EC, Stark AR, editors. Manual of neonatal care. 5th ed. Philadelphia: Lippincott Williams & Willkins; 2004. p. 185-221.
3. Bhutani VK, Johnson L. Prevention of severe neonatal hyperbilirubinemia in healthy infants of 35 or weeks of gestation: implementation of a systemsô€—based approach. J Pediatr. 2007;83,289-93.
4. Mendezô€—Sanchez N, Valadez ER, Flores MA, Vazquez CR, Uribe M. Zinc salts precipitate unconjugated bilirubin in vitro and inhibit enterohepatic cycling of bilirubin in hamsters. Eur J Clin Invest. 2001;31:773-80.
5. Mendezô€—Sanchez N, Martinez M, Gonzalez V, Valadez ER, Flores lvtA. Zinc sulfate inhibits the enterohepatic cycling of unconjugated bilirubin in subjects with Gilbert's syndrome. Ann Hepatol. 2002;1:40-3.
6. Hoque A, Ali KS. Role of zinc in low birth weight neonates. Bangldesh Med J. 2009;38,24-30.
7. Rana N. Efficacy of zinc in reducing hyperbilirubinemia among high risk neonates: a double blind randomized trial. [cited 25 March 2010]. Available from: www.clinicaltrials. gov!ct2/show/NCT00692224.
8. Setiawati A, Muchtar A. Faktorô€—faktor yang mempengaruhi respons penderita terhadap obat. In: Ganiswarna SG, editor. Farmakologi dan terapi. 4th ed. Jakarta: Bagian Fannakologi Fakultas Kedokteran Universitas Indonesia; 1995. p. 820-9.