Neonatal Jaundice Medication

Updated: Dec 28, 2017
  • Author: Thor WR Hansen, MD, PhD, MHA, FAAP; Chief Editor: Muhammad Aslam, MD  more...
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Medication

Medication Summary

Medications are not usually administered in infants with physiologic neonatal jaundice. However, in certain instances, phenobarbital, an inducer of hepatic bilirubin metabolism, has been used to enhance bilirubin metabolism. Several studies have shown that phenobarbital is effective in reducing mean serum bilirubin values during the first week of life. Phenobarbital may be administered prenatally in the mother or postnatally in the infant.

In populations in which the incidence of neonatal jaundice or kernicterus is high, this type of pharmacologic treatment may warrant consideration. However, concerns surround the long-term effects of phenobarbital on these children. Therefore, this treatment is probably not justified in populations with a low incidence of severe neonatal jaundice. Other drugs can induce bilirubin metabolism, but lack of adequate safety data prevents their use outside research protocols.

Intravenous immunoglobulin (IVIG) at 500 mg/kg has been shown to significantly reduce the need for exchange transfusions in infants with isoimmune hemolytic disease. [38] The mechanism is unknown but may be related to the way the immune system handles red cells that have been coated by antibodies. Published experience is still somewhat limited, but administration of immunoglobulin does not appear to be likely associated with greater risks for the infant than an exchange transfusion. Published data regarding efficacy are varied, perhaps having to do with different study sets-up, as studies that show effects of IVIG as far as reducing exchange transfusion have used this drug in a rescue modailty only. One may also speculate that the specific origin and characteristics of the IVIG preparation could play a role. Although speculative, lack of efficacy of a specific IVIG product may warrant trial of one from a different manufacturer or batch.

A new therapy currently under development consists of inhibition of bilirubin production through blockage of heme oxygenase. This can be achieved through the use of metal mesoporphyrins and protoporphyrins. Apparently, heme can be directly excreted through the bile; thus, inhibition of heme oxygenase does not result in accumulation of unprocessed heme. This approach may virtually eliminate neonatal jaundice as a clinical problem. However, before the treatment can be applied on a wide scale, important questions regarding the long-term safety of the drugs must be answered. Also, in light of data suggesting that bilirubin may play an important role as a free radical quencher, a more complete understanding of this putative role for bilirubin is required before wholesale inhibition of its production is contemplated.

Supplementation of probiotics appears to show promise for newborns with pathologic neonatal jaundice. A systematic review and meta-analysis of 13 randomized controlled trials involving 1,067 neonates with jaundice who received probiotics showed a reduction in total serum bilirubin levels after 3, 5, and 7 days, as well as a decrease in the time of jaundice fading, the duration of phototherapy, and length of hospitalization relative to neonates in the control group. [83]  The investigators did not find any reports of serious adverse events.

Zinc sulfate supplementation is a controversial potential approach for treating neonatal jaundice. A systematic review and meta-analysis comprising data from 645 neonates over 5 randomized controlled trials did not show any significant reductions in levels of total serum bilirubin on days 3 and 7, nor reductions in the incidence of bilirubinemia and phototherapy requirements, but zinc supplementation did result in a significantly shorter duration of phototherapy. [84]