The Effect of Purgative Manna and Clofibrate on Neonatal Unconjugated Hyperbilirubinemia
This study was conducted to determine the effect of purgative Manna and clofibrate on unconjugated hyperbilirubinemia of term neonates. In this randomized clinical trial study, sixty neonates suffering from unconjugated hyperbilirubinemia were evaluated. The neonates were divided into three groups using balanced block randomization. Group A (control group-received only phototherapy), group B (intervention group-received purgative Manna and phototherapy) and group C (intervention group-received clofibrate and phototherapy). After the intervention, the amount of serum bilirubin reduction was compared between groups. There was no significant difference among group A, B, and C in terms of serum bilirubin reduction in 24, 48 and 72 hours after starting the intervention (P>0.05). The hospital stays in the control group was significantly longer than the intervention groups (P<0.05). No side effects were observed related to using purgative Mienna and clofibrate. The present study showed that prescribing of purgative Manna and clofibrate has no effect on reduction of serum bilirubin level in term neonates with unconjugated hyperbilirubinemia. Thus, it seems that the administration of these drugs is not necessary. Further studies in this regard are recommended.
2. Kaplan M, Wong RJ, Sibley E, Stevenson DK. Neonatal jaundice and liver disease. In: Martin RJ, Fanaroff AA, Walsh MC, Fanaroff, Martin s, eds. Neonatal-Perinatal Medicine Diseases of the fetus and infant. Phila, Saunders, 2015:1618-1670.
3. Lucia P, Martin RC, Cloherty JP. Neonatal hyperbilirubinemia. In: Cloherty JP, Eichenwald Ec, Hansen AR, Stark AR, eds. Manual of neonatal care.7th ed. Phila, Lippincott Williams & Wilkins, 2012:304-339.
4. Olusanya BO, Ogunlesi TA, Slusher TM. Why is kernicterus still a major cause of death and disability in low-income and middle-income countries? Arch Dis Child 2014;99:1117-21.
5. American Academy of Pediatrics Subcommittee on hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004;114:297-316.
6. Phyllis A, Dennery. Pharmacological interventions for the treatment of neonatal jaundice. Semin Neonatol 2002 ;7:111-9.
7. Azadbakht M, Pishva N, Mohammadi Samani S, Alinejad F. The Effect of Purgative Manna on the Infant Jaundice. Iran J Pharm Sci 2005:1:95-100.
8. Fallah R, Fallahzadeh MA, Noori-Shadkam M. Evaluation of safety and efficacy of purgative manna (billinaster drop) and glycerin suppository in icterus of healthy term newborns. Curr Drug Saf 2014;9:29-33.
9. Habibi M, Mahyar A, Ayazi P, Ahmadabadi F, Javadi A. The effect of clofibrate on hyperbilirubinemia of term neonates. Acta Med Iran 2012;50:21-5.
10. Xiong T, Chen D, Duan Z, Qu Y, Mu D. Clofibrate for unconjugated hyperbilirubinemia in neonates: a systematic review. Indian Pediatr 2012;49:35-41.
11. Fallah R, Islami Z, Lotfi SR. Single dose of 50 mg/kg clofibrate in jaundice of healthy term neonates: randomised clinical trial of efficacy and safety. Indian J Pediatr 2012;79:194-7.
12. Amine G. Iranian medicinal plants and traditional drugs, Tehran. Farhang Press, 1991; PP. 143 – 4.
13. Sheikh Alreiss AS. Ghanoon dar Teb, eds. Translated to Persian by: Shefkandi Abdolrahman. 4th ed. Tehran, Entesharat Sorush; 1991:314.
14. Dennery PA. Pharmacological interventions for the treatment of neonatal jaundice.Semin Neonatol 2002;7:111-9.
15. Malloy MJ, Kane JP. fibric acid derivatives. In: Katzung BG, Masters SB, Trevor AJ. Basic and clinical pharmacology. 12th ed. New York: Mac Graw Hill, 2012:628-629.
16. Bilinaster-Herbal-Drop. (Accessed October 2015, at http://www.darukade.com.)
17. Khoshdel A, Kheiri S. Effect of shir-e-khesht (billinaster drop) consumption by the neonates or their mothers on the neonatal icter. J Shahrekord Univ Med Sci 2011;13:67-73.
18. Ghotbi F, Nahidi Sh, Zangi M. Surveying the effect of cotoneaster spp. (shir khesht) on neonatal jaundice. Res
Med 2006, 30:353-61.
19. Shah Farhat A, Mohammadzadeh A, Ramezani M, Amiri M. The effect of Shirkhesht on newborns’ indirect hyperbilirobinemia. J Iran Univ Med Sci 2005;47:93-8.
20. Mansouri M, Ghotbi N, Bahadorbeigi L. Evaluation of the preventive effects of purgative manna on neonatal icterus inSanandaj. Sci J Kurdistan Univ Med Sci 2012;17:30-5.
21. Nabavizadeh SH, Safari M, Khoshnevisan F. The effect of herbal drugs on neonatal jaundice. Iran J Pediatr 2005;15:133-8.
22. Yin J, Wennberg RP, Miller M. Induction of hepatic billirubin and drug metabolizing enzymes by individual herbs present in the traditional Chinese medicine, yin zhi huang. Dev Pharmacol Ther 1993;20:186-94.
23. Kumar P, Adhisivam B, Vishnu Bhat B. Clofibrate as an Adjunct to Phototherapy for Unconjugated Hyperbilirubinemia in Term neonates. Indian J Pediatr 2017;84:763-7.
24. Eghbalian F, Monsef F, Alam Ghomi N, Monsef A. Effect of low versus moderate dose of clofibrate on serum bilirubin in healthy term neonates with indirect hyperbilirubinemia.Iran J Med Sci 2013;38:349-50.
25. Al-Asy HM, El-Sharkawy HM, Mabrouk MM1, Hamad MR. Effect of fenofibrate on indirect neonatal hyperbilirubinemia. J Clin Neonatol 2015 4:82-86.
26. Hamidi M, Zamanzad B, Mesripour A. Comparing the effect of clofibrate and phenobarbital on the newborns with hyperbilirubinemia. EXCLI J 2013;22:75-8.
27. Gholitabar M, McGuire H, Rennie J, Manning D, Lai R. Clofibrate in combination with phototherapy for unconjugated neonatal hyperbilirubinaemia. Cochrane Database of Systematic Reviews, 2012.
28. Cuperus FJ, Hafkamp AM, Hulzebos CV, Verkade HJ. Pharmacological therapies for unconjugated hyperbilirubinemia. Curr Pharm Dis 2009;15:2927-38.
29. Chawla D. Clofibrate in neonatal hyperbilirubinemia. Indian J Pediatr 2017;84:735-736.