الفهرس | Only 14 pages are availabe for public view |
Abstract Unconjugated bilirubin is produced by the catabolism of heme in the reticuloendothelial system. Jaundice, or yellowish discoloration of the skin, can occur due to an increased amount of bilirubin pigment in the blood. Neonatal jaundice is a common condition among newborns throughout the world. More than half of term and preterm neonates developed neonatal jaundice in their first week of life. More than 60% of neonates develop jaundice during the first week of life. Mostly, in these neonates, the level of serum bilirubin lies within the physiologic range. Between 6% and 15% of neonates develop hyperbilirubinaemia serum total bilirubin (STB) levels that have a high likelihood of requiring intervention to prevent bilirubin toxicity). Neonates with severe hyperbilirubinaemia was in danger because of possible accumulation of bilirubin in tissues, particularly in the brain causing bilirubin induced encephalopathy and its chronic sequelae such as cerebral palsy, sensorineural hearing loss, intellectual difficulties or gross developmental delays. Several lines of evidence suggest the importance of intestinal metabolism of unconjugated bilirubin (UCB) in the pathogenesis of neonatal jaundice. Moreover, it has been recently postulated that increased enterohepatic circulation (EHC) of bilirubin that may occur with ileal inflammation, resection or bypass results in biliary hypersecretion of bilirubin with enhanced black pigment gallstone formation. Enterohepatic circulation may be exaggerated in the neonatal period, in part because the newborn intestinal tract is not yet colonized with bacteria that convert unconjugated bilirubin (UCB) to urobilinogens and because intestinal beta glucuronidase activity is high. Zinc is one of the essential elements in neonatal growth, protein synthesis and regulation of inhibitory and stimulatory synapses of the brain. Zinc lower the bilirubin levels by inhibition of the normal enterohepatic circulation of unconjugated bilirubin (UCB). Oral zinc salts, which flocculate at physiological pH, reduce the serum total bilirubin, presumably by precipitating unconjugated bilirubin from unsaturated micellar solution of bile salts and consequently inhibit the enterohepatic circulation of bilirubin. The aim of the study was to evaluate the effect of oral zinc therapy on healthy term neonate developed jaundice during treatment with phototherapy. In our randomized clinical trial a total of 100 fullterm healthy neonate ages 2-7 days with uncomplicated physiological jaundice whom required phototherapy were enrolled in the study. Neonates with Rhesus, blood group isoimmunisation, with major gross congenital anomaly, sepsis and Neonates whom required treatment for jaundice within 24 hours of birth were excluded from the study. Parental consent was obtained before the study and the neonates included in the study were randomly assigned to one of two groups.: Group(1): to whom oral zinc, in a dose of 5 mg twice daily from 2-5 days in combination with phototherapy, the drug was administered into the mouth of the infant by the plastic measure. group (2): was received phototherapy without oral zinc. The total serum bilirubin level was measured at the beginning, 12 hours, 24 hours for both groups. These cases were obtained from NICU Department, Faculty of Medicine, Menoufia University Hospital . The cases were admitted during the period between January 2016 and January 2017. Our results showed that: There was no statistical significant difference between both groups regarding method of delivery, gender, gestational age, age on admission. There was no statistical significant difference between both groups regarding previous sibling with jaundice, previous sibling needing phototherapy. There was no statistical significant difference between both groups regarding laboratory test, neonatal blood group and maternal blood group. There was no statistical significant difference between both groups regarding body weight on admission and show significant difference and more body weight gain in group (1). There was a statistical significant difference between both groups regarding decrease total bilirubin level at 12h.24h in group (1) compared to group(2) and no significant difference regarding total bilirubin level on admission. There was statistical significant difference regarding less duration of phototherapy in group (1) compared to group (2. There was no statistical significant difference between both groups regarding occurrence of vomiting, rash, diarrhea as a side effect during study. We concluded that administration of oral zinc decreases serum UCB levels and decrease the duration of phototherapy in neonatal jaundice. |