agar and Jaundice--Neonatal

In the neonate, hyperbilirubinaemia is usually due to a combination of an increased bilirubin load and decreased bilirubin elimination. Despite an understanding of the enzymatic pathways leading to bilirubin production and elimination, very few pharmacological interventions to prevent hyperbilirubinaemia are utilized and the mainstay of treatment remains phototherapy. Previously studied pharmacological agents such as D-penicillamine, phenobarbital and clofibrate may yet prove useful. Recent clinical trials using metalloporphyrins to inhibit heme catabolism and bilirubin production provides a novel pharmacological intervention for the treatment of neonatal jaundice. The safety and efficacy of these therapies will need to be confirmed prior to widespread use.

Topics: Agar; Bilirubin; Charcoal; Clofibrate; Drugs, Chinese Herbal; Heme; Humans; Infant, Newborn; Jaundice, Neonatal; Liver Circulation; Metalloporphyrins; Oxidoreductases; Oxidoreductases Acting on CH-CH Group Donors; Penicillamine; Phenobarbital; Treatment Outcome

Neonatal jaundice is one of the most common problems leading to prolonged hospitalization of the newborn. Therefore, an effective low-risk, low-cost therapy reducing hospitalization is highly desirable. Plain dried agar, an extract of seaweed, is low cost and low risk; it can bind bilirubin in the gut, decreasing its enterohepatic circulation, thereby decreasing serum levels. Because of conflicting conclusions in the studies of agar's effectiveness in the prevention and treatment of neonatal jaundice, a meta-analysis of their methodologies was done. Criteria for assessing prospective controlled therapeutic trials of agar were established in six areas: hypothesis and clinical outcome, patient selection, treatment group allocation, therapeutic maneuver, use of cotherapies, and data analysis. Nine prospective clinical trials of agar therapy were evaluated using these six criteria. The seven studies with negative conclusions regarding agar's efficacy failed to meet the criteria in several categories: patient selection, therapeutic maneuver, use of cotherapies, or data analysis. All of the studies, including the positive studies, were at risk for biased treatment allocation. Although the pooled data analysis suggests that prophylactic agar treatment is associated with reduced peak serum bilirubin levels, this observation must be interpreted cautiously in light of heterogenous patient populations and the methodologic problems described. Based on this meta-analysis, agar therapy for neonatal jaundice can neither be recommended nor rejected. The methodologic analysis gives clear guidance for future research concerning the effectiveness of agar in treating neonatal jaundice and provides a model for meta-analysis of other prospective trials in pediatrics.

Topics: Agar; Bilirubin; Combined Modality Therapy; Humans; Infant, Newborn; Jaundice, Neonatal; Meta-Analysis as Topic; Research Design

Topics: Agar; Cholestyramine Resin; Humans; Infant, Newborn; Jaundice, Neonatal; Phenobarbital; Phototherapy; Riboflavin

Topics: Agar; Animals; Bilirubin; Breast Feeding; Female; Humans; Hyperbilirubinemia; Infant, Newborn; Jaundice, Neonatal; Kernicterus; Male; Milk, Human; Oxytocin; Phenobarbital; Photochemistry; Phototherapy

Topics: Agar; Animals; Bile Pigments; Bilirubin; Carbon Radioisotopes; Charcoal; Chemical Phenomena; Chemistry; Chromium Radioisotopes; Erythrocyte Aging; Female; Fetus; Globins; Hematopoiesis; Hemoglobins; Humans; Infant, Newborn; Intestinal Mucosa; Jaundice, Neonatal; Liver; Liver Circulation; Maternal-Fetal Exchange; Pregnancy; Resins, Plant

To determine the value of oral agar in the treatment of neonatal hyperbilirubinemia and to compare it with two other treatment modalities: phototherapy alone and phototherapy plus oral agar.. Two hundred eight jaundiced full-term newborns were divided into four groups. They were given either phototherapy alone, phototherapy plus oral agar, oral agar alone, or no treatment (control group). The changes in the serum bilirubin values were determined and the results were compared statistically, mainly using analysis of variance.. In all three therapy groups, the time required to reduce the bilirubin level to either 15 mg/dL or to 10 mg/dL was significantly shorter than that required by the control group. Although oral agar was found to be as effective as phototherapy, the most significant decrease in bilirubin level was in the combination group.. The efficacy of phototherapy in decreasing the serum bilirubin level in neonatal hyperbilirubinemia can be augmented with the use of oral agar. Oral agar can also be used as a single agent for the treatment of neonatal hyperbilirubinemia, since it is as effective as phototherapy.

Topics: Administration, Oral; Agar; Analysis of Variance; Combined Modality Therapy; Exchange Transfusion, Whole Blood; Humans; Infant, Newborn; Jaundice, Neonatal; Phototherapy; Prospective Studies; Treatment Outcome

40 full-term newborn infants with erythrocyte glucose-6-phosphate dehydrogenase (G-6-PD) deficiency were used for a study concerning the effectiveness of agar per os in preventing severe hyperbilirubinemia. 20 randomly selected neonates were given agar (1 g/kg/day) orally in 4 daily doses from their 1st to their 5th day of life. 20 infants were not treated and served as controls. Three exchange transfusions were performed in the experimental as well as in the control group. According to these results, agar does not seem to be effective in preventing severe hyperbilirubinemia, which frequently occurs in newborn infants with erythrocyte G-6-PD deficiency.

Topics: Administration, Oral; Agar; Bilirubin; Clinical Trials as Topic; Drug Evaluation; Female; Glucosephosphate Dehydrogenase Deficiency; Humans; Infant, Newborn; Jaundice, Neonatal; Male

Topics: Administration, Oral; Agar; Bilirubin; Birth Weight; Female; Humans; Infant, Newborn; Jaundice, Neonatal; Male; Methods; Phototherapy

Topics: Agar; Bacteria; Bilirubin; Birth Weight; Blood Group Antigens; Body Weight; Clinical Trials as Topic; Feces; Female; Glucuronidase; Hematocrit; Humans; Hyperbilirubinemia; Infant, Newborn; Intestinal Absorption; Intestinal Mucosa; Intestines; Jaundice, Neonatal; Leukocyte Count; Liver; Male; Reticulocytes

Phototherapy increases the biliary excretion of unconjugated bilirubin. In this form, bilirubin would be subject to enterohepatic circulation, and the true efficacy of phototherapy would be blunted. We tested the hypothesis that sequestration of lumenal unconjugated bilirubin by enteral agar administration would enhance the efficacy of phototherapy in jaundiced infants. Fifty-two infants were studied, 21 control and 31 agar-supplemented. The birth weights, sex distribution, and postnatal age at onset of phototherapy did not differ between the two groups of infants; pre- and post-phototherapy bilirubin concentrations also did not differ between the groups. The bile acid concentrations and bilirubin saturation indices were also similar. The rate of declination of the plasma bilirubin concentrations after 24 h of phototherapy was greater and significantly more uniform in the agar-supplemented infants (-1.59 +/- 2.3 versus -2.51 +/- 1.44). Stool frequencies were greater in control infants (5.5 versus 4.3 per 24 h) whereas fecal bilirubin excretions were greater in agar-supplemented infants during the second day of phototherapy (1.32 versus 3.29 mg . kg-1 . 24 h-1). Agar supplementation reduced the duration of phototherapy by 23% (37.6 +/- 3.2 versus 48.1 +/- 5.0 h).

Topics: Agar; Bilirubin; Enteral Nutrition; Female; Humans; Infant, Newborn; Jaundice, Neonatal; Male; Phototherapy; Prospective Studies; Time Factors

Topics: Agar; Bibliographies as Topic; Bilirubin; Brain; Enzyme Induction; Estrogens; Glucuronosyltransferase; History, 15th Century; History, 18th Century; History, 20th Century; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Intestinal Absorption; Jaundice, Neonatal; Kernicterus; Lipid Metabolism; Meconium; Microsomes, Liver; Milk, Human; Oxytocin; Phototherapy; Progesterone; Serum Albumin; Solubility

An study on the effect of p.o. agar in neonatal bilirubin seric levels is reported. Two groups of healthy newborns, 33 terms and 22 pre-terms were studied after ingestion of agar and the results compared to those in a similar set of non-agar control groups. Agar ingestion decreased bilirubin levels in term newborns and increased fecal elimination of the pigment (p less than 0.001). p.o. agar had no effect on the levels of serum bilirubin in preterm newborns (p greater than 0.05).

Topics: Administration, Oral; Agar; Bilirubin; Feces; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Intestinal Absorption; Jaundice, Neonatal

49 jaundiced, nonimmunized newborn infants with a birth weight of more than 2,000 g were given phototherapy with white light for more than 36 h. The average period of treatment was 61 h. 24 infants received 250 mg agar at the beginning of each meal at 3-hour intervals during phototherapy. 25 infants received phototherapy only. Serum bilirubin levels were decreased similarly in both groups. It is concluded that ingestion of agar does not supplement the effect of phototherapy.

Topics: Agar; Age Factors; Bilirubin; Birth Weight; Gestational Age; Humans; Infant, Newborn; Jaundice, Neonatal; Phototherapy

Topics: Administration, Oral; Agar; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Jaundice, Neonatal; Male

The effect of orally administered agar on the serum concentration of bilirubin was tested in 366 premature and newborn infants. For this purpose two different concentrations of agar were added to the milk for 8-10 days. On none of the groups tested did the serum level of bilirubin show a significant decrease after administration of agar. Therefore the attempt to lower the level of serum bilirubin in premature and newborn infants by inhibiting enteric reabsorption by means of adsorbents must be considered a failure.

Topics: Agar; Bilirubin; Exchange Transfusion, Whole Blood; Humans; Hyperbilirubinemia; Infant, Newborn; Infant, Premature; Jaundice, Neonatal

Topics: ABO Blood-Group System; Agar; Bilirubin; Birth Weight; Breast Feeding; Depression, Chemical; Female; Humans; Infant Food; Infant, Newborn; Jaundice, Neonatal; Male; Rh-Hr Blood-Group System

Topics: Agar; Albumins; Exchange Transfusion, Whole Blood; Female; Humans; Infant, Newborn; Jaundice, Neonatal; Phenobarbital; Phototherapy; Pregnancy

Topics: Agar; Bilirubin; Body Weight; Diet Therapy; Female; Humans; Infant Nutritional Physiological Phenomena; Infant, Newborn; Jaundice, Neonatal; Male; Time Factors

Topics: Agar; Humans; Infant, Newborn; Jaundice, Neonatal; Orotic Acid; Phenobarbital; Phototherapy

Topics: Agar; Diagnosis, Differential; Erythroblastosis, Fetal; Exchange Transfusion, Whole Blood; Female; Glucosephosphate Dehydrogenase Deficiency; Humans; Hyperbilirubinemia; Infant, Newborn; Jaundice, Neonatal; Kernicterus; Phenobarbital; Phototherapy; Pregnancy; Urinary Tract Infections; Virus Diseases

Topics: Adult; Agar; Bile; Bile Acids and Salts; Bilirubin; Cholesterol; Humans; Infant, Newborn; Intestinal Absorption; Intestinal Mucosa; Jaundice, Neonatal; Liver