jaundice

There has been significant interest in using Cotoneaster for treating jaundice or elevated bilirubin levels in newborns, and it has, in many cases, replaced phototherapy in herbal medicine. However, using these compounds to treat hyperbilirubinemia can lead to complications in neonates, potentially resulting in morbidity and even death.

This study examined the side effects of Cotoneaster consumption in jaundiced neonates admitted to the Children’s Medical Center between 2021 and 2022.

We conducted a cross-sectional study involving healthy neonates who consumed Cotoneaster following treatment for neonatal jaundice and subsequently experienced complications. The data were recorded using pre-prepared questionnaire forms.

The most common complications following Cotoneaster derivatives were exaggerated hyperbilirubinemia, dehydration, and poor feeding.

Given the sensitivity of neonates, the treatment of jaundice in babies should be approached with caution and supported by extensive studies. The use of herbal medicines in neonates remains questionable due to associated complications.

Infantile jaundice affects up to 84% of term infants and is a primary cause of re-hospitalization. Phototherapy, the primary therapeutic intervention, may be associated with several complications. Therefore, employing additional compensatory therapies could reduce the duration of phototherapy and its adverse effects.
A single-blind randomized clinical trial was conducted on newborns with indirect hyperbilirubinemia (IHB) undergoing phototherapy. Patients were randomly assigned to two groups: the intervention group received phototherapy and 10mg/kg of Ursodeoxycholic acid, taken twice a day with water as the solvent, while the control group received phototherapy and a placebo (water). Total bilirubin levels were measured every 12 hours, and the groups were compared regarding the reduction duration of bilirubin <10 mg/dl and the duration of phototherapy. Data analysis used SPSS-V22 software, with statistical tests done at a significance level of <0.05.
In total, 128 neonates, comprising 56 (43.8%) males and 72 (56.2%) females, with a mean gestational age of 39.02±0.86 weeks and a mean age of 2.77±1.45 days, were subjected to analysis. After 96 hours, the mean bilirubin level was 9.23±2.81 mg/dl overall, 7.27±2.12 mg/dl in the case group, and 10.91±2.17 mg/dl in the control group (p<0.001). The mean time to reach a bilirubin level below 10 mg/dl was 51.66±17.27 hours overall, 58.38±10.05 hours for the case group, and 62.61±14.39 hours for the control group (p<0.001).
Ursodeoxycholic acid (UDCA) effectively reduces elevated bilirubin levels and the duration of phototherapy when employed as an adjunct treatment to phototherapy in cases of infantile indirect hyperbilirubinemia.

Lemmel syndrome occurs when the primarily intrapancreatic portion of the common bile duct is compressed or obstructed by a duodenal diverticulum. This can cause jaundice due to the pressure.

A 65-year-old female patient was admitted to the emergency room with Lemmel syndrome. The patient underwent endoscopic retrograde cholangiopancreatography (ERCP), confirming the diagnosis of a diverticulum. The papilla was located in the diverticulum, and despite various attempts and maneuvers, it could not be cannulated. Subsequently, percutaneous transhepatic cholangiography (PTC) was performed, and an 8F drainage catheter was successfully placed in the duodenum.

Lemmel syndrome is a rare condition that may cause acute abdomen with obstructive jaundice. Increased awareness and familiarity with imaging can help distinguish the diverticulum from tumors, potentially saving the patient from unnecessary surgeries. If ERCP fails, PTC may be a successful alternative for the treatment of jaundice.

Exchange transfusion (ET) is an effective treatment for acute bilirubin encephalopathy and extreme neonatal hyperbilirubinemia (ENH). It can reduce mortality and morbidity. This study aimed to investigate the trends and risk factors of ENH requiring ET in hospitalized neonates in Iran. A retrospective analysis of medical records of neonates who underwent ET due to ENH was conducted from 2011 to 2021, in Shiraz, Iran. Clinical records were used to gather demographic and laboratory data. The quantitative data were expressed as mean±SD, and qualitative data was presented as frequency and percentage. P<0.05 was considered statistically significant. During the study, 377 ETs were performed for 329 patients. The annual rate of ET decreased by 71.2% during the study period. The most common risk factor of ENH was glucose-6-phosphate dehydrogenase (G6PD) deficiency (35%), followed by prematurity (13.06%), ABO hemolytic disease (7.6%), sepsis (6.4%), Rh hemolytic disease (6.08%), and minor blood group incompatibility (3.34%). In 28.52% of the cases, the cause of ENH was not identified. 17 (5.1%) neonates had acute bilirubin encephalopathy, of whom 6 (35.29%) had G6PD deficiency, 6 (35.29%) had ABO incompatibility, and 2 (11.76%) had Rh incompatibility. Although the rate of ET occurrence has decreased, it seems necessary to consider different risk factors and appropriate guidelines for early identification and management of neonates at risk of ENH should be developed. The findings of the study highlighted the important risk factors of ENH in southern Iran, allowing for the development of appropriate prevention strategies.

The rate of neonatal jaundice is increasing. Due to the complications associated with phototherapy, researchers have consistently sought alternative methods, including herbal remedies.

In this study, we conduct a systematic review and meta-analysis to investigate the impact of Purgative manna consumption on the serum bilirubin levels of neonates.

In this systematic review and meta-analysis, we conducted an online search on various databases, including Barakat Gostar, scientific information database (SID), Magiran, IranDoc, PubMed, Scopus, Web of Science, Cochrane and the Google Scholar search engine, without time restrictions, up to July 20, 2023. Data analysis was performed using the STATA software, version 14. Meanwhile, the significance level was considered P<0.05.

We examined 12 clinical trial articles, involving a total of 1557 neonates. Before the intervention, there was no statistically significant difference in the bilirubin levels of neonates between the two groups (standardized mean difference [SMD]=-0.02; 95% confidence interval [CI], -0.12%, 0.09%; P=0.473). After Cotoneaster consumption, the serum bilirubin levels of the intervention group decreased (SMD=-3.50; 95% CI, -5.76%, -1.24%; P=0.000). Following phototherapy, the bilirubin levels of the control group also decreased (SMD=-2.14; 95% CI, -4.01%, -0.27%; P=0.000). After the intervention, at 12 h (SMD=-0.45; 95% CI, -0.80%, -0.10%; P=0.000), 24 h (SMD=-0.63; 95% CI, -1%, -0.26%; P=0.000), 36 h (SMD=-0.95; 95% CI, -1.69%, -0.20%; P=0.000), 48 h (SMD=-0.62; 95% CI, -0.92%, -0.31%; P=0.000), and 72 h (SMD=-0.84; 95% CI, -1.40%, -0.29%; P=0.000) post-intervention, the bilirubin levels of neonates in the Cotoneaster group were lower compared to the control group.

Cotoneaster consumption is more effective than phototherapy alone in reducing the bilirubin levels of neonates.

Neonatal jaundice is a common clinical problem caused by the deposition of bilirubin in the tissue. Natural products have long been used to treat jaundice, and Iranian medicine can be a good source of natural treatments for this purpose. In this study, we investigate the mechanism of the effect of Cotoneaster, an Iranian herbal medicine, in the treatment of jaundice in neonates.

We investigated every article that evaluated Purgative manna, Cotoneaster manna, or Cotoneaster in the treatment of neonatal jaundice. We searched the databases of PubMed, Scopus, Web of Sciences, SciELO, CNKI, and Google Scholar for English articles, and a search was also done in Persian in Magiran and Scientific Information Database (SID) published until August 2023.

The exact mechanism of Cotoneaster in reducing jaundice is not known, but the following mechanisms have been suggested .The most common mechanisms include increased urination, increased bile excretion from the liver, and increased defecation, as well as neutralizing the effects of oxidative agents and free radicals.

 Considering that most studies have stated that Cotoneaster combined with phototherapy is effective in treating jaundice and herbal medicines alone cannot treat jaundice. Therefore, identifying the mechanism of Cotoneaster in reducing jaundice can lead to the creation of methods to strengthen its effect. More detailed biochemical and pharmacological studies are needed to understand the mechanism of action of Cotoneaster in reducing neonatal jaundice.

 The use of herbal drugs for treating neonatal jaundice is a common practice in many societies despite the potential complications. However, little is known about the individuals or groups who typically recommend the use of these drugs for affected neonates.

 This study aims to investigate the main recommendations of herbal drugs for treating neonatal jaundice.

 The format of the present cross-sectional study was designed and implemented based on interviews with parents of infants who have infantile jaundice who used herbal drugs for their neonates during 2019 and 2022 and were admitted to the Children’s Medical Center of Tehran, Iran. Along with baseline data, the socioeconomic situation of families was also evaluated.

 Regarding the role of people in recommending the use of herbal drugs, in 52.1% of cases, the main recommenders to use this substance to treat infant jaundice were the patient's relatives, while the role of parents in recommending the consumption of this compound was 25.5%. Also, 6.4% of the neighbors of the patients’ family were the main recommenders to use herbal drugs for the affected neonates. Interestingly, 4.3% of doctors and 11.7% of pharmacists had the leading role in recommending the use of herbal drugs to treat infant jaundice. Parents who recommended using herbal drugs for their neonates were more likely to be smokers and less affluent.

 Relatives, parents, grandparents, and even neighbors play a significant role in recommending the use of herbal drugs in the treatment and control of neonatal jaundice. The role of doctors and pharmacists in recommending the use of this compound in the treatment of jaundice, especially considering the potential side effects, should not be underestimated.

 Most cases of newborn hyperbilirubinemia are physiologic; however, excessive unconjugated bilirubin is a potential neurotoxin. Phototherapy treats moderate to severe hyperbilirubinemia. If phototherapy increases immunoglobulin G (IgG) clearance, there is a chance of humoral immune disorders.

 The purpose of the study was to investigate the effect of phototherapy on the level of IgG in neonates.

 This study investigated 40 full-term newborns with hyperbilirubinemia. Blood samples were taken before and 72 hours after phototherapy. The IgG level was measured by calorimetry tests.

 Phototherapy resulted in a decrease in IgG levels. The IgG level significantly decreased from 833.135 to 720.185 mg/dL. Before phototherapy, 12.5% of the population had low IgG levels; however, 32.5% had low IgG levels after the treatment.

 According to the results of the study, intensive phototherapy caused a reduction in IgG levels. Since there was no significant decrease in IgG levels in neonates who received conventional phototherapy, it can be concluded that this treatment is safe in terms of IgG levels.

. Hemophagocytic lymphohistosis (HLH) is a life-threatening clinical syndrome that involves liver dysfunction and can range from mild dysfunction to severe fulminant insufficiency. Cholestasis, which is a frequent finding in many severe newborn illnesses, may also be a symptom of HLH. Therefore, HLH should be considered in the differential diagnosis of all cholestatic patients with cytopenia. In this report, we identified a case of HLH with cholestasis. The patient met at least seven out of the eight requirements of the HLH-2004 criteria. The infant had a stable fever, jaundice (conjugated hyperbilirubinemia), cytopenia, elevated liver enzymes, high ferritin, low fibrinogen, and triglyceride. Although urine, blood, and cerebrospinal fluid (CSF) culture tests were negative, CSF analysis revealed 80 WBCs, including 68% polymorphonuclear neutrophils (PMNs), more than 100000 RBCs, 71 mg/dL sugar, 82 mg/dL protein and 102 U/L lactate dehydrogenase. Coagulation tests and TORCH screen were normal. We confirmed the diagnosis of HLH with a bone marrow aspiration test and started treatment with dexamethasone. An intravenous dose of dexamethasone (4 mg) was administered, followed by 1.5 mg daily with pressure control, which stopped the fever after 24 hours.

Case report:

 The patient was a 21-day-old infant with a birth weight of 3450 g. He developed fever and jaundice 10 days after a normal delivery, and he was referred to Sarakhs Hospital when he was 14 days old and hospitalized for 3 days. Later, he was sent to Ghaem Hospital and admitted to the Neonatal Intensive Care Unit. The infant had a stable fever, jaundice (conjugated hyperbilirubinemia), cytopenia, elevated liver enzymes, high ferritin, low fibrinogen, and triglyceride. According to his mother, there was no history of any problems from birth, and the baby's jaundice started after the first week. Examinations showed abdominal distention and hepatosplenomegaly. Due to neonatal cholestasis and fever, he underwent a complete sepsis workup with vancomycin and cefotaxime. Although urine, blood, and cerebrospinal fluid (CSF) culture tests were negative, CSF analysis revealed 80 WBCs, including 68% polymorphonuclear neutrophils, more than 100000 RBCs, 71 mg/dL sugar, 82 mg/dL protein, and 102 U/L lactate dehydrogenase. Coagulation tests and TORCH screen were normal. We confirmed the diagnosis of hemophagocytic lymphohistiocytosis (HLH) with a bone marrow aspiration test and started treatment with dexamethasone. An intravenous dose of dexamethasone (4 mg) was administered, followed by 1.5 mg daily with pressure control, which stopped the fever after 24 hours.

HLH is uncommon in the neonatal stage, and aberrant clinical and laboratory findings suggestive of HLH can be found in a variety of conditions. The severity of this condition makes it crucial to get a diagnosis as soon as possible. In the presence of additional variables, such as cytopenia and hyperferritinemia, HLH should be considered in the differential diagnosis of cholestasis in a neonate.

Jaundice is the most prevalent reason for infants’ hospitalization during their first month of birth, and herbal medicine has long been used alongside phototherapy to treat this problem. 

The present systematic review investigates chicory’s influence on bilirubin levels in infants with jaundice. 

In this systematic review study, Iranian databases, including Barekat Gostar, Scientific Information Database (SID), Irandoc, and Magiran, along with international databases, including Cochrane Library, Web of Science, Scopus, PubMed, and Google Scholar search engines were explored with relevant keywords to retrieve pertinent studies. 

Among the 7 selected articles with a sample size of 408 (204 people in the intervention group and 204 in the control group) from 2006 to 2020, 4 studies were in vitro and 3 were randomized clinical trials. Among these studies, mothers’ pregnancy duration ranged between 30.9 and 38.8 weeks, infants’ age ranged between 3 and 7 days, and their weight ranged between 1544 and 3316 g. Although chicory administration varied across the studies, 4 studies reported its effectiveness in reducing infants’ bilirubin, whereas the other 3 articles reported no effect of chicory on bilirubin levels in infants. 

Iran was the only country that evaluated the effect of chicory on neonatal jaundice in the form of several research studies. However, due to the limited number of studies and the different dosages of chicory, the way of consuming chicory, the type of studies, and the age and weight of babies, we could not reach a general conclusion on the efficacy of chicory.

Neonatal jaundice is one of the most common diseases in neonatal medicine. Phototherapy is a safe and secure method and is one of the most common treatments of indirect hyperbilirubinemia. This study aimed to evaluate the effect of home phototherapy in neonatal hyperbilirubinemia in Urmia. The present study is a cross-sectional study by the Cohort method. Two hundred three full-term infants older than 24 hours, who were referred to phototherapy for home phototherapy for two months, were selected as the study population. Neonatal serum bilirubin levels in both groups were measured at the beginning and 24 hours after phototherapy. The collected data were analyzed by using SPSS-20. In this study, the mean neonatal bilirubin level before phototherapy was 14.33 ±2.41 mg/dl before and 8.11 ± 2.29 mg/dl after phototherapy. The reduction rate of bilirubin after home phototherapy was 6.6 mg/dl per day and these differences were statistically significant. During phototherapy at home, phototherapy was successful in 96.6% of the neonates recovered, and only seven neonates (3.4%) had complications. Due to the lower prevalence of complications and low duration of treatment, it can be concluded that home phototherapy can be a good alternative for the treatment of neonatal jaundice. Therefore, this method is recommended for the treatment of neonatal jaundice through proper phototherapy training at home.

Phototherapy is the most common treatment of neonatal jaundice that affects the zinc level as well as the bilirubin level.

The purpose of this study is to investigate the effect of phototherapy on the zinc level of infants with jaundice by a systematic review and meta-analysis.

In this systematic review and meta-analysis a comprehensive literature search of the databases, including Cochrane Library, Web of Science, PubMed, Scopus, and Google Scholar web browser was conducted using standard keywords. Data analysis of this meta-analysis was performed using STATA software, version 14 and P<0.05 was considered a significant level for tests. 

In the five studies reviewed in this article with a sample size of 398 individuals, phototherapy increased the level of zinc [Standardized mean difference (SMD): 0.88 (95% CI: 0.38, 1.38), P<0.001] and decreased bilirubin level [SMD: -7.67 (95% CI: -9.11, -6.23), P<0.001] in infants with jaundice. The effect of phototherapy was on the zinc level of these groups: infants with a birth weight of 3000 to 3300 grams (gr) [SMD: 1.07 (95% CI: 0.42, 1.71), P<0.001] and 3301 to 3600 gr [SMD: 0.40 (95% CI: -0.32, 1.12), P=0.028], three-day-old infants [SMD: 1.05 (95% CI: 0.35, 1.74), P<0.001], four-day-old [SMD: 0.76 (95% CI: 0.26, 1.32)], and 5-day-old ones [SMD: 0.23 (95% CI: -0.01, 0.48)]. In addition, phototherapy affected on zinc level of those whose gestational age (GA) was 37 [SMD: 1.12 (95% CI: 0.06, 2.17), P<0.001] and 38 [SMD: 0.61 (95% CI: 0.15, 1.06), P=0.001] weeks.

Phototherapy by reducing the level of bilirubin increases the level of zinc in infants with jaundice. So, the standardized mean difference of “phototherapy effects on the zinc level of infants with jaundice” decreases with increasing infants’ weight, increasing infants’ age, and increasing gestational age.

Early diagnosis and treatment of Wilson's disease in childhood can reduce long-term and life-threatening complications in these patients. Considering the lack of a database of Wilson's patients in Iranian patients, the present study was carried out with the primary objective of determining clinical and laboratory presentations in children with Wilson's disease referred to Akbar Hospital in Mashhad.

This cross-sectional descriptive study was conducted on children under 18 years of age with Wilson's disease who had presented to Akbar Children's Hospital in Mashhad during 2018-2019. The acquired information included demographic information, primary clinical symptoms (hepatic, cerebral, and psychological symptoms), and laboratory findings, including liver laboratory profile (AST, ALT, and ALP tests), coagulation tests, albumin, total serum protein, and direct and indirect bilirubin, and Wilson's diagnostic tests.

In total, 25 patients with an average age of 15.88±4.54 years were included in this study. Hepatosplenomegaly, Kayser–Fleischer ring, and jaundice were observed in 72%, 68%, and 48% of patients, respectively. Gender of patients was not significantly correlated with the clinical and laboratory findings of Wilson’s disease (P<0.05). 24-hour urine copper level was higher than 100 micrograms in 82.6% of patients. Serum ceruloplasmin level was lower than 200 mg/liter in 90% of patients. Serum ceruloplasmin levels in patients with ascites (P=0.04) and patients with lower limb edema (P=0.02) were higher than those in patients without these findings. Moreover, a lower 24-hour urinary copper level was detected in patients with seizures (P=0.03), and patients with depression (P=0.005) compared to patients without these conditions. The 24-hour urine copper levels were higher in patients with jaundice than in those without jaundice (P=0.01).

Hepatosplenomegaly, Kayser–Fleischer ring, and jaundice are common symptoms in under 18-year-old patients with Wilson's disease. Considering the findings regarding the high levels of serum ceruloplasmin and copper in 24-hour urine in a significant