Efficacy of zinc sulfate on indirect hyperbilirubinemia in premature infants admitted to neonatal intensive care unit: a double-blind, randomized clinical trial

Abstract

Background: Hyperbilirubinemia is a common neonatal problem. Studies conducted on the effectiveness of zinc salts on serum indirect bilirubin levels in newborns have yielded different results, all calling for further research. This study aimed to determine the effect of oral zinc sulfate on indirect hyperbilirubinemia in preterm infants admitted to the neonatal intensive care unit. Methods: A randomized double-blind clinical trial was performed in the neonatal intensive care unit of Vali-e-Asr Hospital in Birjand, Iran. The study population comprised neonates aged between 31 and 36 gestational weeks, who required phototherapy in the neonatal intensive care unit. A total of 60 neonates were selected by census and allocated into an experimental group and a control group. In addition to phototherapy, the experimental group received 1 cc/Kg zinc sulfate syrup (containing 5 mg/5 cc zinc sulfate; Merck Company, Germany), and the control group received a placebo syrup (containing 1 cc/kg sucrose). Data were analyzed in SPSS-21 software using the independent t-test, repeated-measures ANOVA, Bonferroni post-hoc test, and Mann-Whitney test. P-values smaller than 0.05 were considered significant. Results: Bilirubin level changes in the experimental and control groups six hours after intervention were − 1.45 ± 3.23 and − 0.49 ± 0.37 (p = 0.024), respectively. The changes 24 and 48 h after intervention were-3.26 ± 2.78 and − 1.89 ± 1.20 (p = 0.017) in the experimental group and − 4.89 ± 2.76 and − 3.98 ± 2.32 (p = 0.23) in the control group, respectively. There was no significant difference in the phototherapy duration between the two groups (p = 0.24). Conclusions: The results of this study showed that the use of zinc sulfate syrup in preterm infants with indirect hyperbilirubinemia significantly reduced bilirubin levels within 48 h of treatment.

WITHDRAWN: Zinc Supplementation in Preterm Neonates with Jaundice: Is It Beneficial?

“…the nding of our study in the bene cial effect of Zn in preterm neonate in decreasing the serum bilirubin levels was agreed with some studies which found signi cant decrease in serum bilirubin levels in preterm infants who were given Zn supplementation if compared with those who did not receive Zn supplementation [14].…”

Earlier Nutrient Fortification of Breastmilk Fed LBW Infants Improves Jaundice Related Outcomes

“…These findings followed previous animal studies which showed that zinc supplements reduced TSBR [30]. Zinc has been shown to increase bowel movements and therefore bilirubin fecal excretion, which in turn reduces the enterohepatic circulation of bilirubin [29]. We speculate that the earlier supplementation of zinc from fortification may also have allowed to the F80 group to manage bilirubin excretion more efficiently.…”

“…Zinc is another constituent of nutrient supplement that has been demonstrated to improve bilirubin elimination. A recent randomized, double blind trial demonstrated that neonates between 31 and 36 weeks gestation requiring phototherapy, had significantly reduced jaundice within 48 h of receiving oral zinc [29]. These findings followed previous animal studies which showed that zinc supplements reduced TSBR [30].…”

Neonatal hyperbilirubinemia: Background and recent literature updates on the diagnosis and treatment

“…Supplementation of a suspension of fenofibrate and vitamin D, E, and C during white light therapy significantly reduced bilirubin levels and the duration of phototherapy in neonates [76]. The administration of oxaliplatin in combination with fluro-pyrimidine/folinic acid and monoclonal antibody, and supplementation of zinc sulfate syrup and Yinzhihuang oral liquid during phototherapy are also effective for reduction of bilirubin in neonates [77][78][79].…”