Fenofibrate As an Adjuvant to Phototherapy in Term Neonates with Hyperbilirubinemia; A Randomized Controlled Clinical Trial

Khafaga, Khaled Abouelenin; Alsaid, Lofty Mohamed; Salama, Raafat Hassan; Abougabal, Maged Taher

doi:10.21608/ejhm.2022.258459

Cited by 4 publications

(5 citation statements)

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“…Many previous RCTs have evaluated fenofibrate as an adjunctive treatment to phototherapy in neonates with elevated levels of indirect bilirubin [94][95][96][97]. Fibrate is a class of phenoxy-isobutyric acid derivative, which consists of peroxisome proliferator-activated alpha receptor agonists, used as a lipid-lowering drug that can also enhance bilirubin conjugation and excretion through the induction of UGT1A1.…”

Section: Fibratementioning

confidence: 99%

“…Fibrate is a class of phenoxy-isobutyric acid derivative, which consists of peroxisome proliferator-activated alpha receptor agonists, used as a lipid-lowering drug that can also enhance bilirubin conjugation and excretion through the induction of UGT1A1. A group of researchers reported that a single dose of fenofibrate at a dose of 10 mg/kg during phototherapy in newborns is associated with a significant reduction in serum bilirubin levels [94]. Another study failed to demonstrate a statistically significant difference in the rate of bilirubin reduction despite the shorter duration of phototherapy [98].…”

Section: Fibratementioning

confidence: 99%

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“Light” on Phototherapy—Complications and Strategies for Shortening Its Duration, A Review of the Literature

Shoris,

Gover,

Toropine

et al. 2023

Children

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Neonatal hyperbilirubinemia is an extremely common metabolic complication of the neonatal period which may be associated with bilirubin encephalopathy and even death. Adverse neurological consequences are preventable if a timely diagnosis and treatment are provided. Phototherapy is usually the preferred option to decrease hyperbilirubinemia. Although considered to be safe, evidence in recent years has shown that this treatment may not be free of side effects and short- and long-term unfavorable outcomes. These are usually mild or rare, but should be decreased or avoided if possible. Many useful complementary measures and treatments have been described that could shorten the duration of exposure to phototherapy. However, there is no current unequivocal recommendation to use any of the methods presented in this review. Our review aims to depict the wide range of possible complementary treatments to phototherapy, and to provide the scientific and clinical evidence available regarding their usefulness. It is essential that, while utilizing the full potential of phototherapy to treat hyperbilirubinemia, caregivers are aware of its side effects and possible inherent dangers, and seek ways to minimize the exposure to phototherapy to what is really needed for the newborn. Further studies are needed to clarify the preferred complementary treatments that could reduce the duration of exposure to phototherapy without impairing its effectiveness.

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Section: Fibratementioning

confidence: 99%

Section: Fibratementioning

confidence: 99%

“Light” on Phototherapy—Complications and Strategies for Shortening Its Duration, A Review of the Literature

Shoris,

Gover,

Toropine

et al. 2023

Children

View full text Add to dashboard Cite

show abstract

“…Fibrate, as a lipid-lowering drug, can enhance bilirubin conjugation and excretion through the induction of UGT1A1 (12). Fibrates are a class of phenoxy-isobutyric acid derivatives, which are peroxisome proliferator-activated alpha receptor agonists.…”

Section: Fibratesmentioning

confidence: 99%

“…Additionally, clofibrate processes the transfer of albumin-bound bilirubin to hepatocytes and induces hepatic uptake and conjugation of bilirubin (13). Numerous RCTs assessed fenofibrate as an adjuvant to phototherapy in neonates with IHB (12)(13)(14)(15)(16). Khafaga et al revealed that a single dose of fenofibrate (10 mg/kg) as an adjuvant to phototherapy in neonates with hyperbilirubinemia was associated with a significant reduction of serum bilirubin levels (12).…”

Section: Fibratesmentioning

confidence: 99%

“…Numerous RCTs assessed fenofibrate as an adjuvant to phototherapy in neonates with IHB (12)(13)(14)(15)(16). Khafaga et al revealed that a single dose of fenofibrate (10 mg/kg) as an adjuvant to phototherapy in neonates with hyperbilirubinemia was associated with a significant reduction of serum bilirubin levels (12). Chaudhary et al demonstrated that fenofibrate appears to be an effective and safe drug for the treatment of neonatal IHB, consistent with the results of a previous study (15).…”

Section: Fibratesmentioning

confidence: 99%

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Recent Advances in Adjuvant Pharmacotherapy for Neonatal Indirect Hyperbilirubinemia: A Narrative Review

Nouri

Zarkesh

2023

J Compr Ped

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Context: Hyperbilirubinemia is a common cause for diagnostic work-up and therapeutic intervention in neonates and needs a convenient, quick, and safe treatment modality. Phototherapy is the most common treatment for neonatal jaundice; however, complementary treatment is still needed. Despite the identification of the enzymatic pathways of bilirubin catabolism, few pharmacological interventions have been found to be effective in reducing bilirubin, along with traditional phototherapy. This review was conducted to evaluate recent pharmacotherapies as adjuvants to phototherapy for the treatment of neonatal indirect hyperbilirubinemia (IHB). Evidence Acquisition: This study was carried out through a literature search with the keywords of Infant, Newborn, and Indirect Hyperbilirubinemia, combined with Drug Therapy, in PubMed, Scopus, International Statistical Institute, Web of Science, Cochrane, and Embase databases. This study included relevant articles (i.e., randomized controlled trials, observational studies, guidelines, and reviews) written in English and published between 2012 - 2022. Results: This narrative review first assessed the relevant articles to define IHB and its etiology. Then, the efficacy and side effects of recent pharmacologic agents as adjuvants to phototherapy were discussed. Additionally, this study reviewed the efficacy and safety of drugs prescribed to neonates to prevent jaundice. Conclusions: The best drug for adjuvant pharmacotherapy, in addition to phototherapy, for neonatal jaundice has not still been identified. The use of probiotics, prebiotics, synbiotics, and ursodeoxycholic acid (UDCA) in adjuvant to phototherapy has been recently increasing, and beneficial results were observed in most studies. The use of agar, charcoal, fibrate, and phenobarbital had a minor therapeutic role in recent years. There were conflicting results about the efficacy of herbal agents in neonatal jaundice. The use of intravenous immunoglobulin (IVIG), metalloporphyrin, and albumin is also limited to severe or immune-related IHB cases. The prescription of the aforementioned drugs sometimes had different results. Therefore, further research in this regard is necessary.

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Different approaches in management of neonatal unconjugated hyperbilirubinemia: a review article

Fouly,

Bendas,

Farid

et al. 2024

Futur J Pharm Sci

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Background Neonatal hyperbilirubinemia is a prevalent condition that affects newborns, characterized by elevated serum bilirubin levels. The accumulation of bilirubin can cause neurotoxicity, resulting in various complications, and in severe cases, even mortality. The underlying pathophysiology of this condition primarily involves an inconsistency between the synthesis and excretion of bilirubin. Despite the short- and long-term side effects of phototherapy, it is considered a core treatment of neonatal hyperbilirubinemia. Exchange transfusion is considered a last resort in cases where phototherapy fails. Several studies have investigated the use of various agents either to replace phototherapy or to be added as adjuvants to reduce the time required for phototherapy and hence minimize the adverse effects. Some of these studies have demonstrated positive outcomes, indicating their effectiveness, while others have failed to yield any significant differences in treatment duration. Main text The present review summarized the etiology of neonatal hyperbilirubinemia. It was demonstrated that neonatal hyperbilirubinemia has mainly two types: Conjugated and unconjugated hyperbilirubinemia. Treatment options for neonatal hyperbilirubinemia were discussed with phototherapy as the most prevalent and successful option followed by exchange transfusion. Side effects of phototherapy were also discussed together with the different approaches introduced to clinical practice to minimize these side effects. Conclusion Phototherapy is the most successful treatment of neonatal hyperbilirubinemia, although its side effects are of great concern. Studies introducing adjuvants such as zinc sulfate and ursodeoxycholic acid have demonstrated promising results in reducing the duration of phototherapy and minimizing the side effects. However, these results are inconclusive, and further research is required to validate the safety and efficacy of these adjuvants.

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Fenofibrate As an Adjuvant to Phototherapy in Term Neonates with Hyperbilirubinemia; A Randomized Controlled Clinical Trial

Cited by 4 publications

References 5 publications

“Light” on Phototherapy—Complications and Strategies for Shortening Its Duration, A Review of the Literature

“Light” on Phototherapy—Complications and Strategies for Shortening Its Duration, A Review of the Literature

Recent Advances in Adjuvant Pharmacotherapy for Neonatal Indirect Hyperbilirubinemia: A Narrative Review

Different approaches in management of neonatal unconjugated hyperbilirubinemia: a review article

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