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Nikouei M, Cheraghi M, Mansouri M, Hemmatpour S, Moradi Y. The effect of oral zinc sulfate supplementation on hospitalized infants with hyperbilirubinemia: a double-blind randomized clinical trial. Eur J Pediatr 2024:10.1007/s00431-024-05739-5. [PMID: 39172170 DOI: 10.1007/s00431-024-05739-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 08/15/2024] [Accepted: 08/17/2024] [Indexed: 08/23/2024]
Abstract
Previous investigations on the impact of oral zinc sulfate treatment on newborns' serum bilirubin levels have produced conflicting results. As a result, the goal of this clinical study was to evaluate how oral zinc sulfate affected the levels of serum bilirubin in term infants who were admitted to the neonatal intensive care unit. The study was conducted at the Neonatal Care Unit of Besat Hospital in Sanandaj, Kurdistan Province, as a double-blind randomized controlled trial. The participants included term infants (37-42 weeks of gestation) who required phototherapy and were admitted to the neonatal intensive care unit. A total of 290 infants were enrolled and randomly divided into two groups. The intervention group received oral zinc sulfate supplementation at a dosage of 1 mg/kg per day in addition to phototherapy, while the placebo group received an equivalent amount of placebo daily. Bilirubin measurements were obtained at the initiation of the intervention and subsequently every 24 h until discharge. The collected data were analyzed using STATA software version 17. After the infants were randomly allocated to the zinc-sulfate and placebo groups, the study outcomes, including the average changes in bilirubin levels after intervention, the hours of phototherapy, and the number of days of hospitalization, were analyzed and compared for a total of 160 infants in the zinc sulfate group and 130 infants in the placebo group. The reduction in bilirubin levels in infants receiving zinc sulfate was (- 3.75 ± 0.19 CI 95% - 4.12, - 3.37) and for placebo group was (- 1.81 ± 0.15 CI 95% - 2.12, - 1.50) 24 h after the intervention. Furthermore, 48 and 72 h following the intervention, bilirubin levels in the intervention group demonstrated a more substantial decline. The zinc sulfate group had a shorter hospital stay (2.13 ± 0.04 vs. 2.83 ± 1.42) and required less phototherapy hours than the placebo group (6.21 ± 2.16 vs. 8.78 ± 1.40). Conclusions: Oral zinc sulfate supplementation in term neonates with hyperbilirubinemia decreased the level of bilirubin levels, duration of phototherapy, and hospital stay. Trial registration: IRCT, IRCT20220806055625N1. Study Registered 25 December 2022, http://irct.ir/trial/66,722 .
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Affiliation(s)
- Maziar Nikouei
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mojtaba Cheraghi
- Cancer and Immunology Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Majid Mansouri
- Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Siros Hemmatpour
- Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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Al-Matary A, AlGhamdi A, Alenaze B, Mandili RA, Alhawsawi DA, Magzoub D, Abu-Zaid A. Therapeutic benefits of zinc sulfate on neonatal hyperbilirubinemia. World J Pediatr 2022; 18:300-304. [PMID: 35257309 DOI: 10.1007/s12519-022-00532-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/18/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - Abdullah AlGhamdi
- Department of Pediatrics, King Abdullah Specialized Children Hospital, King Abdulaziz Medical City, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Research Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Bandar Alenaze
- Department of Pediatrics, King Abdullah Specialized Children Hospital, King Abdulaziz Medical City, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Research Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | | | - Duha Magzoub
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Ahmed Abu-Zaid
- Department of Pharmacology, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, 38163, USA. .,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
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Effect of Zinc on Hyperbilirubinemia of Newborns, a Randomized Double Blinded Clinical Trial. CURRENT HEALTH SCIENCES JOURNAL 2020; 46:250-254. [PMID: 33304626 PMCID: PMC7716768 DOI: 10.12865/chsj.46.03.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 09/06/2020] [Indexed: 11/25/2022]
Abstract
Background: Jaundice is one of the most common causes of hospitalization in newborn infants. Zinc may have a possible role as a cofactor of enzymes in the metabolism of bilirubin and can prevent red blood cell destruction as an antioxidant agent. The present study aims to investigate the effect of zinc in the treatment of neonatal hyperbilirubinemia. Material&Methods: In this double-blind, randomized clinical trial, 112 healthy newborns with idiopathic neonatal hyperbilirubinemia were divided into two groups receiving zinc and placebo. The case and control group received 10mg of zinc and placebo daily. The total bilirubin levels in the second, third, fourth and fifth day and duration of hospitalization and phototherapy were compared. Results: The mean total bilirubin value in the second to fifth days in the zinc group were 11.95±2.35, 9.49±1.79, 8.54±1.63 and 8.64±0.96 respectively, and in the placebo group were 12.95±2.73, 9.88±2.35, 9.5±2.9 and 10.16±0.86 respectively and there was no significant difference between two groups. The duration of phototherapy and hospitalization in the zinc and placebo groups did not show any significant difference. Conclusion: We did not find a significant reduction in serum bilirubin levels nor the duration of hospitalization in neonates receiving zinc sulfate compared to control group.
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Faal G, Khatib Masjedi H, Sharifzadeh G, Kiani Z. Efficacy of zinc sulfate on indirect hyperbilirubinemia in premature infants admitted to neonatal intensive care unit: a double-blind, randomized clinical trial. BMC Pediatr 2020; 20:130. [PMID: 32192467 PMCID: PMC7081620 DOI: 10.1186/s12887-020-02025-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/10/2020] [Indexed: 11/10/2022] Open
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. Trial registration Trial registration: IRCT, IRCT2015120825439N1. Registered 21 February 2016, http://irct.ir/trial/21277
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Affiliation(s)
- Gholamreza Faal
- Department of Pediatrics, Faculty of Medicine, Birjand University of Medical Sciences, South Khorasan Province, Birjand, Iran.
| | | | | | - Zahra Kiani
- Faculty of Pharmacy, Birjand University of Medical Sciences, Birjand, Iran
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Bocca B, Ciccarelli S, Agostino R, Alimonti A. Trace elements, oxidative status and antioxidant capacity as biomarkers in very low birth weight infants. ENVIRONMENTAL RESEARCH 2017; 156:705-713. [PMID: 28478178 DOI: 10.1016/j.envres.2017.04.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/01/2017] [Accepted: 04/21/2017] [Indexed: 06/07/2023]
Abstract
Reference data on trace elements, oxidative status and antioxidants in very low birth weight infants (VLBW) are limited and need to be updated for use in clinical settings. Serum and urine of 30 VLBW infants (mean weight, 1167g) at mean age of 23.8 (t0) and 37.8 (t1) days were analyzed. Cadmium (Cd), copper (Cu), iron (Fe), mercury (Hg), manganese (Mn), selenium (Se) and zinc (Zn), nitrate/nitrite (NOx), catalase (CAT), CuZnFeMn-superoxide dismutases (CuZnFeMn-SODs), total antioxidant capacity (SAC: sum of thiols, proteins, bilirubin, uric acid, β-beta-carotene, ascorbic acid, vitamin E) and total oxidative status (SOS: sum of lipo- and hydroperoxides) were determined. A higher urinary excretion of Cu and Zn was observed at t0 than at t1; while an increase in urine Cd was found at t1 respect to t0. A deficiency in serum levels of Cu and Zn was also found. A lower CAT activity, a higher total oxidants level (SOS) and a reduction of total antioxidant barriers (SAC) were observed in some infants. No Fe and Mn deficiency or Hg overload was found; also CuZnFeMn-SODs and NOx levels did not change. The findings showed that losses of trace elements and incomplete mineral body stores were more pronounced in the earlier life stage (at 23.8th day) than later on; moreover, antioxidant defenses were poor and lipo- and hydroperoxides were higher still at 5 weeks of infants' life.
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Affiliation(s)
- Beatrice Bocca
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy.
| | - Simona Ciccarelli
- Neonatal Intensive Care Unit and Neonatal Pathology, S. Giovanni Calibita-Fatebenefratelli Hospital, Rome, Italy
| | - Rocco Agostino
- Member of Etic Committee, Bambino Gesù Paediatric Hospital, Rome, Italy
| | - Alessandro Alimonti
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
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Yang L, Wu D, Wang B, Bu X, Tang J. The influence of zinc sulfate on neonatal jaundice: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2017; 31:1311-1317. [PMID: 28372469 DOI: 10.1080/14767058.2017.1315659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Li Yang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - De Wu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Baotian Wang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaosong Bu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jiulai Tang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Sharma D, Farahbakhsh N, Sharma P, Shastri S. Role of oral zinc supplementation for reduction of neonatal hyperbilirubinemia: a systematic review of current evidence. J Matern Fetal Neonatal Med 2016; 30:1953-1962. [DOI: 10.1080/14767058.2016.1234600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Deepak Sharma
- Department of Pediatrics, Pt B.D Sharma, PGIMS, Rohtak, Haryana, India,
| | - Nazanin Farahbakhsh
- Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran,
| | - Pradeep Sharma
- Department of Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India, and
| | - Sweta Shastri
- Department of Pathology, N.K.P Salve Medical College, Nagpur, Maharashtra, India
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Mosayebi Z, Rahmani M, Behjati Ardakani S, Sheikh M, Shariat M, Rezaeizadeh G. Evaluation of Serum Zinc Levels in Hyperbilirubinemic Neonates Before and After Phototherapy. IRANIAN JOURNAL OF PEDIATRICS 2016; 26:e4146. [PMID: 27617068 PMCID: PMC4992089 DOI: 10.5812/ijp.4146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 02/08/2016] [Accepted: 02/18/2016] [Indexed: 12/04/2022]
Abstract
Background The existing therapeutic methods for neonatal jaundice are costly, time-consuming and potentially risky. Zinc salts can reduce phototherapy duration by precipitating unconjugated bilirubin in the intestine (bilirubin and zinc can form a complex in physiologic pH); however, zinc toxicity is an issue that must be considered since theoretically bilirubin reduction by phototherapy may increase serum zinc levels, making additional zinc supplementation the potential cause of zinc toxicity. Objectives So, our purpose was evaluating the serum zinc level alterations before and after phototherapy, in hyperbilirubinemic newborns. Materials and Methods A prospective cohort study was performed at the children’s medical center of Tehran University of Medical Sciences from 2012 to 2014. Healthy, full-term exclusively breast fed newborns with non-hemolytic jaundice were enrolled in the study. Participants were divided into two groups based on serum bilirubin levels (TSB < 18 mg/dL and TSB ≥ 18 mg/dL) at admission. Pre- and post-phototherapy total serum zinc level was measured before and 12 - 24 hours after termination of phototherapy. Results Phototherapy was associated with a significant increase in the serum zinc level in neonates with severe hyperbilirubinemia (TSB ≥ 18 mg/dL) but not in those with mild-moderate hyperbilirubinemia (TSB < 18 mg/dL). In addition, phototherapy caused a significant increase in the rate of zinc with potentially toxic levels (zinc > 200) in only neonates with severe hyperbilirubinemia. Conclusions Phototherapy increases serum zinc level by reducing bilirubin level so that additional supplementation of this element can lead potentially to zinc toxicity.
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Affiliation(s)
- Ziba Mosayebi
- Breastfeeding Research Center, Family Health Institute, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Maral Rahmani
- Tehran University of Medical Sciences, Tehran, IR Iran
| | | | - Mahdi Sheikh
- Maternal, Fetal and Neonatal Research Center, Family Health Institute, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mamak Shariat
- Maternal, Fetal and Neonatal Research Center, Family Health Institute, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Golnaz Rezaeizadeh
- Maternal, Fetal and Neonatal Research Center, Family Health Institute, Tehran University of Medical Sciences, Tehran, IR Iran
- Maternal, Fetal and Neonatal Research Center, Vali-Asr Hospital, Imam Khomeini Hospital Complex, Tehran, IR Iran
- Corresponding author: Golnaz Rezaeizadeh, Maternal, Fetal and Neonatal Research Center, Vali-Asr Hospital, Imam Khomeini Hospital Complex, P. O. Box: 1419733141, Tehran, IR Iran. Tel: +98-2166591316, Fax: +98-2166591315, E-mail:
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El-Farghali O, El-Wahed MA, Hassan NE, Imam S, Alian K. Early Zinc Supplementation and Enhanced Growth of the Low-Birth Weight Neonate. Open Access Maced J Med Sci 2014; 3:63-8. [PMID: 27275198 PMCID: PMC4877790 DOI: 10.3889/oamjms.2015.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/28/2014] [Accepted: 11/29/2014] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Nutritional deficits are almost universal in Low-Birth Weight babies. Zinc is essential for normal infant growth and its supplementation assists growth probably through insulin-like growth factor-1. AIM: This double-blind randomized-controlled trial aimed at evaluating the role of zinc in catch-up growth of low-birth-weight infants and investigating its proposed mediator. MATERIAL AND METHODS: The study was conducted in Ain Shams University Maternity Hospital. Two hundred low-birth-weight neonates were simply randomized to either oral zinc therapy or placebo. Anthropometric measurements were recorded at birth, 3, 6, and 12 months; including weight, recumbent length, head, waist, chest, and mid-upper arm circumferences, and triceps and sub-scapular skin fold thickness. RESULTS: We found that initial and 3-months measurements, except weight, were comparable in the 2 groups. All measurements at 6- and 12-months, except sub-scapular skin-fold-thickness, were significantly higher in zinc group than placebo. Catch-up growth, at 12-months, was significant in zinc group and was significantly higher in appropriate-for-gestational-age vs. small-for-gestational-age, in preterm vs. term, and in male vs. female infants. The median 6-months insulin-like growth factor-1 levels were significantly higher in zinc group. CONCLUSION: We conclude that early start of oral zinc supplementation in low-birth-weight neonates assists catch-up growth, probably through rise of insulin-like growth factor-1.
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Affiliation(s)
- Ola El-Farghali
- Ain Shams University, Children's Hospital Cairo, Abbassia sq., Cairo 11351, Egypt
| | - Mohamed Abd El-Wahed
- Ain Shams University, Children's Hospital Cairo, Abbassia sq., Cairo 11351, Egypt
| | - Nayera E Hassan
- National Research Centre - Biological Anthropology, National Research Centre, ElBuhose street, Dokki, Giza, Egypt
| | - Safaa Imam
- Ain Shams University, Children's Hospital Cairo, Abbassia sq., Cairo 11351, Egypt
| | - Khadija Alian
- National Research Centre - Biological Anthropology, National Research Centre, ElBuhose street, Dokki, Giza, Egypt
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