NEONATAL JAUNDICE MEDICATIONS
Category: Child Health
Abstract : 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
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.
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