Clofibrate in combination with phototherapy for unconjugated neonatal hyperbilirubinaemia

Gholitabar, Maryam; McGuire, Hugh; Rennie, J. Basil; Manning, Donal; Lai, Rosalind

doi:10.1002/14651858.cd009017.pub2

Cited by 14 publications

(12 citation statements)

References 16 publications

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“…In remote tropical locations where access to conventional treatment is not assured heliotherapy, for example with specially filtered canopies, may be considered to minimise the risk of kernicterus. 99 Evidence to support the use of clofibrate in combination with phototherapy 100 and fluid supplementation for infants who require phototherapy are inconclusive. 101 In recent years intravenous immune globulin (IVIG) has, in some settings, been shown to significantly reduce the need for exchange transfusion in infants with Rhesus or ABO incompatibility.…”

Section: Treatmentmentioning

confidence: 99%

Neonatal hyperbilirubinaemia: a global perspective

Olusanya

Kaplan

Hansen

2018

The Lancet Child & Adolescent Health

207

195

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Hyperbilirubinaemia, presenting as jaundice, is a ubiquitous and frequently benign condition in newborn babies but is a leading cause of hospitalisation in the first week of life. In some infants jaundice can become severe, progressing to acute bilirubin encephalopathy and kernicterus with a substantial risk of neonatal mortality and long-term neurodevelopmental impairments. Severe hyperbilirubinaemia and its sequelae continue to occur in industrialised countries with functioning medical systems and a disproportionately high burden also persists in low-income and middle-income countries due primarily to delays in delivering effective treatments that are routinely available in high-income countries. In this Review we summarise up-to-date evidence on the epidemiology of neonatal jaundice including its global burden based on estimates of its prevalence, and both fatal and non-fatal health outcomes. We also discuss the management of severe hyperbilirubinaemia including the prevention of kernicterus, and highlight future directions for research.

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Section: Treatmentmentioning

confidence: 99%

Neonatal hyperbilirubinaemia: a global perspective

Olusanya

Kaplan

Hansen

2018

The Lancet Child & Adolescent Health

207

195

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“…It seems that clofibrate in combination with phototherapy lowers the level of bilirubin and shortens the duration of phototherapy in term neonates [52,53], but larger trials are needed to evaluate its effect. Further research is especially needed in hemolyticcaused hyperbilirubinemia, as these neonates were excluded in some of the trials [54].…”

Section: Clofibratementioning

confidence: 99%

Neonatal management and outcome in alloimmune hemolytic disease

Ree

Smits-Wintjens

Bom

et al. 2017

Expert Review of Hematology

103

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Introduction: Hemolytic disease of the fetus and newborn (HDFN) occurs when fetal and neonatal erythroid cells are destroyed by maternal erythrocyte alloantibodies, it leads to anemia and hydrops in the fetus, and hyperbilirubinemia and kernicterus in the newborn. Postnatal care consists of intensive phototherapy and exchange transfusions to treat severe hyperbilirubinemia and top-up transfusions to treat early and late anemia. Other postnatal complications have been reported such as thrombocytopenia, iron overload and cholestasis requiring specific management. Areas covered: This review focusses on the current neonatal management and outcome of hemolytic disease and discusses postnatal treatment options as well as literature on long-term neurodevelopmental outcome. Expert commentary: Despite major advances in neonatal management, multiple issues have to be addressed to optimize postnatal management and completely eradicate kernicterus. Except for strict adherence to guidelines, improvement could be achieved by clarifying the epidemiology and pathophysiology of HDFN. Several pharmacotherapeutic agents should be further researched as alternative treatment options in hyperbilirubinemia, including immunoglobulins, albumin, phenobarbital, metalloporphyrins, zinc, clofibrate and prebiotics. Larger trials are warranted to evaluate EPO, folate and vitamin E in neonates. Long-term follow-up studies are needed in HDFN, especially on thrombocytopenia, iron overload and cholestasis.ARTICLE HISTORY

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“…In addition, these mothers pointed out the need to develop other methods of treatment of Neonatal Jaundice, which could ease the separation of the binomial, such as the use of some medication, but although there are some drugs described in the literature, which are effective in decreasing or inhibiting the increase of serum bilirubin, 21,22 they are usually used together with phototherapy, and the best evidence of treatment for jaundice is still the use of light, with fewer direct side effects to the neonate. 1 It is considered insufficient to invest only in technology with high-emission phototherapy system by optical fiber, in order to minimize mother-child separation and the risk of injury to the corneas of the newborn, but concomitantly to work with the staff issues related to humanization in care.…”

Section: Discussionmentioning

confidence: 99%

From suffering to resignation: Grounded Theory approach to maternal experience with newborn in phototherapy

Nascimento¹,

Avila

Bocchi

2018

Rev. Bras. Saude Mater. Infant.

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Objectives:understanding the experience of puerperal womenwith newborn in phototherapy treatment in rooming-in care.Methods:qualitative research analyzed according to the Grounded Theory and the results discussed in the light of Symbolic Interactionism. The interviews were audiotaped and transcribed in full. The theoretical saturation was based on the analysis of the 15th interview with puerperal women, undergoing the experience in the maternity of the Public Hospital of São Paulo State.Results:from the analysis emerged four categories (sub processes): getting disappointed with the bad news; feeling recluse, separated from her baby, accountable and with not enough support for care; resigning to the protective role of mother of a baby in suffering and at risk; seeking strategies to deal with the situation. From the realignment of these categories (sub processes) emerged the core category (process): from suffering to resignation in order to deal with the maternal experience with NB in phototherapy.Conclusions:the symbolic intervening component, mother's protective role, prompted her to attempt to cope with the challenging experience by feeling compelled to exercise the function of caretaker. The same way that the rooming-in care team emerged in the experience of the mother, using the same symbol, to hold her accountable for constant vigilance in maintaining the integrity of baby's vision.

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Clofibrate in combination with phototherapy for unconjugated neonatal hyperbilirubinaemia

Abstract: Analysis 1.2. Comparison 1 Phototherapy + clofibrate 100 mg/kg versus phototherapy alone in preterm and term neonates, Outcome 2 Mean total serum bilirubin (mg/dL

Cited by 14 publications

References 16 publications

Neonatal hyperbilirubinaemia: a global perspective

Neonatal hyperbilirubinaemia: a global perspective

Neonatal management and outcome in alloimmune hemolytic disease

From suffering to resignation: Grounded Theory approach to maternal experience with newborn in phototherapy

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