Is Oral Agar Combined with Phototherapy Superior than Phototherapy in Treatment of Neonatal Indirect Hyperbilirubinemia

Abstract

Background: Neonatal jaundice is the commonest condition encountered during daily practice of neonatologists. Phototherapy remains the main-stay in the treatment. However, its safety and efficacy still questioned. Agar was proposed as an adjuvant therapy to improve the effectiveness and safety profile of bilirubin. However, the evidence is still building up. The current work aimed to address the value of agar as an adjuvant to phototherapy for neonatal hyperbilirubinemia of full-term neonates.

Methods: The study was a randomized double-blind comparable clinical trial. Full term neonates with indirect hyperbilirubinemia within their first week of life at the level of phototherapy were included. Patients were randomly assigned into two equal groups. The phototherapy alone group, where newborns received 10 ml of distilled water by bottle every 12 hours. The second group, where neonates received 300 mg/kg of agar orally by bottle every 12 h before feedings in 10 ml of distilled water. The collected data for comparison included patient demographics and serial measurements of total serum bilirubin (TSB). Treatment was stopped when TSB levels falls to 2 mg/dl below the phototherapy initiation threshold.

Results: Both groups were comparable regarding patient demographics, mode of delivery and gestation age at delivery.  TSB levels showed significant progressive reduction after the first, at the third and the fifth days of therapy among agar and comparable groups.  The percentage of reduction in TSB levels was significantly higher in phototherapy-Agar combination group than the other group at third day of therapy (- 38.92 versus - 28.66%, p=0.0001). Finally, the length of hospital stay duration was significantly shortened with agar than the other group (3.34±0.70 vs 3.7 ±0.74, p=0.014).

Conclusion: Adding oral agar to phototherapy improves the effectiveness and safety among full-term neonates with indirect hyperbilirubinemia.