NEONATAL JAUNDICE MEDICATIONS

neonatal jaundice medications usually are not administered in infants with physiologic neonatal jaundice. However, in certain instances, phenobarbital, an inducer of hepatic bilirubin metabolism, has been used to enhance bilirubin metabolism. Several studies have shown that phenobarbital is effective in reducing mean serum bilirubin values during the first week of life. Phenobarbital may be administered prenatally in the mother or postnatally in the infant.

In populations in which the incidence of neonatal jaundice or kernicterus is high, this type of pharmacologic treatment may warrant consideration. However, concerns exist regarding the long-term effects of phenobarbital on these children. Therefore, this treatment is probably not justified in populations with a low incidence of neonatal jaundice.

Other drugs can induce bilirubin metabolism, but lack of adequate safety data prevents their use outside research protocols. IV immunoglobulin (500 mg/kg) has been shown to significantly reduce the need for exchange transfusions in infants with isoimmune hemolytic disease. The mechanism is unknown but may be related to the way the immune system handles red cells that have been coated by antibodies. Experience is somewhat limited, but it does not appear likely that administration of immunoglobulin incurs greater risks for the infant than an exchange transfusion.

A new therapy currently under development consists of inhibition of bilirubin production through blockage of heme oxygenase. This can be achieved through the use of metal mesoporphyrins and protoporphyrins. Apparently, heme can be excreted directly through the bile; thus, inhibition of heme oxygenase does not result in accumulation of unprocessed heme. This approach may virtually eliminate neonatal jaundice as a clinical problem.

However, before the treatment can be applied on a wide scale, important questions regarding the long-term safety of the drugs must be answered. Also, in light of data suggesting that bilirubin may play an important role as a free radical quencher, a more complete understanding of this putative role for bilirubin is required before wholesale inhibition of its production is contemplated.