{"id":2756,"date":"2015-04-28T07:35:56","date_gmt":"2015-04-28T07:35:56","guid":{"rendered":"http:\/\/biomedpharmajournal.org\/?p=2756"},"modified":"2020-04-26T07:41:22","modified_gmt":"2020-04-26T07:41:22","slug":"the-effect-of-manna-of-hedysarum-prescription-on-the-decrease-of-bilirubin-level-in-lcteric-neonates","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol6no2\/the-effect-of-manna-of-hedysarum-prescription-on-the-decrease-of-bilirubin-level-in-lcteric-neonates\/","title":{"rendered":"The Effect of Manna of Hedysarum Prescription on the Decrease of Bilirubin Level in Lcteric Neonates"},"content":{"rendered":"

\u00a0Introduction<\/strong><\/p>\n

Hyperbilirubinema is one of the common problems that cause the most case of hospitalization of neonates. \u00a0Approximately 60 percent of term neonates and 80 percent of premature neonates \u00a0are afflicted to \u00a0jaundice in the first week of their life.\u00a0 The cause of this disease is the accumulation of color pigments in the skin of neonates(1).\u00a0 In normal circumstances, the level of total bilirubin in serum of umbilical cord is 1 \u2013 3 mg\/dl and the speed of its increase is approximately less than 5 mg\/dl per day.\u00a0 Therefore, \u00a0\u00a0the jaundice\u00a0 \u00a0demonstrates itself after 2 to 3 days following birth. Following 2 days, it increases and then subsides gradually. \u00a0Usually after one week it ends. \u00a0However, such is not the case for some neonates.\u00a0 The accumulation keeps raising to the point that hospitalization and prompt treat is necessary. \u00a0\u00a0Kernicterus is an dangerous complication \u00a0of indirect hyper bilirubinemia that\u00a0 its demonstrates itself in the form of\u00a0\u00a0 acute neurological syndrome.\u00a0 This syndrome is associated with high morbidity and mortality rate in neonates and the cases who survive face various disorders such as seizure, hearing disturbances, extrapyramidal signs, bilateral choreoathetosis, and muscle spasms (1).<\/p>\n

Phototherapy is \u00a0\u00a0known as the most common way of treatment and prophylaxis for hyperbilirubinemia that in the majority of the cases results in decrease in the level of bilirubin concentration (2).\u00a0 Applying phototherapy in hospital results in the separation of mother from her neonate. This condition not only causes emotional stress for the mother but also causes financial burden for the family as well. The use of phototherapy at home is difficult and needs special facility.<\/p>\n

Other treatment methods include consuming non absorbable food substances that have the likelihood of attaching to bilirubin at the intestine region and through the reduction of interohepatic cycle result in slowing of the bilirubin absorption in the intestine, thus lowering its level in the serum.\u00a0 Activated charcoal, \u00a0\u00a0agar and cholestyramine are three of the know substances that are used as the treatment to reduce bilirubin level in neonates.\u00a0 However, routine application of such substances needs further controlled clinical examinations.<\/p>\n

In addition,\u00a0 \u00a0Manna of hedysarum is another plantar substance that had been used in herbal medicine or traditional medicine to treat jaundice in neonates.\u00a0 However, no clinically examined research in this regard is available.\u00a0\u00a0 Therefore, prescription of such substance as a medication needs further research including considerable number of subjects.\u00a0 The result of a careful literature review of PubMed data base revealed a limited number of references with one study including the human subjects (2-8).\u00a0 \u00a0\u00a0Manna of hedysarum is a plant product that contains carbohydrate components (5). \u00a0Its scientific name is Alhagi pseudoal hagi and traditionally had been used as a\u00a0 laxative medicine in addition to using it as the medicine for coughing, infectious fevers in children.\u00a0 A 5 percent humid Manna of hedysarum contains 47.7 percent melzitoze sugar, 26.44 percent sucrose and\u00a0\u00a0 11.5 percent fructose (4).<\/p>\n

Tarhani (3) conducted a research \u00a0and used this medicine \u00a0for treatment of hyperbilirubinemia in hospitalized neonates.\u00a0 In this research, the neonates that were afflicted to jaundice, the experimental group was treated with phototherapy treatment in addition to oral \u00a0Manna of hedysarum as a complementary medication.\u00a0 \u00a0The result of study indicated that the level of bilirubin in serum of the experimental group who received Manna of hedysarum decreased more than the phototherapy group who served as the control group.\u00a0 However, this difference was not statistically significant.<\/p>\n

The effectiveness of medications for treatment of hyperbilirubinemia may be enhanced by changing the doses of Manna of hedysarum.\u00a0 However in that case, placing the neonate in the hospital creates the separation anxiety for the parent as well as the financial stress. \u00a0Therefore, if an effective medication is found that prevents the increase in bilirubin level of neonate, it will decrease the need to hospitalization and reduce the emotional\u00a0 stress of mother\u00a0 separation from her neonate in addition to \u00a0the financial cost of\u00a0 treatment.<\/p>\n

For this purpose this research was designed to determine the effectiveness of Manna of hedysarum in non-hospitalized neonates patient that were diagnosed by a pediatrician with a bilirubin level of less than 15 mg\/dl.<\/p>\n

Material and Methods<\/strong><\/p>\n

In this double blind clinical research, the neonate patients diagnosed by a pediatrician as suffering from jundice with bilirubin level between 10 to 15 mg\/dl participated.\u00a0 These patients at the time of examination by the physician did not need to be hospitalized but were advised to follow their bilirubin level.\u00a0 The patients were randomly assigned into two group of experimental and control groups.\u00a0 The experimental group received \u00a0\u00a0Manna of hedysarum extract 20 percent\u00a0 for three times per day. The extract was prepared by Barij Essence Company where as the control group received placebo solution that contained water only.<\/p>\n

The neonates who were full term and weighed over 2.5 kg with bilirubin level over 10 to 15 mg\/dl were included in the research.\u00a0 The neonates that were preterm or weighed less than 2.5 kg or suffered fromdirect hyperbilirubinemia or had other diseases like infectious diseases were excluded from the research. \u00a0The use of this medication in the traditional medicine was explained to the parents of the neonates and if they gave their consent to use the treatment for their neonate, they were included in the study. Following a complete description of the procedure and use of this plant medicine in traditional treatment of jaundice, the mothers of the neonates signed a human consent form.<\/p>\n

Statistical analysis of data was performed by using SPSS:PC version 12.0.\u00a0 Statistical test of significances including two-way analysis of variance repeated measure , and post hoc tests were employed to analyze the data. All the statistical tests were examined at the alpha level set to 0.05.<\/p>\n

Analysis<\/strong><\/p>\n

In this research a total of 50 neonates were examined. Table 1 presents the frequency of the patients according to their age group. Since the age\u00a0 group included the neonates below one week \u00a0or more \u00a0than one week, chi squared test of proportion\u00a0 revealed that there was\u00a0 no significant differences between the proportion of\u00a0 this two age groups (p>0.05).<\/p>\n

Table 1: frequency distribution of the neonates according to the age \u00a0<\/strong><\/p>\n\n\n\n\n\n\n
age<\/strong><\/p>\n

treatment<\/strong><\/td>\n

\u00a0Less than one week<\/strong><\/td>\n\u00a0 \u00a0\u00a0\u00a0one week or more<\/strong><\/td>\ntotal<\/strong><\/td>\n<\/tr>\n
\u00a0\u00a0Manna of hedysarum extract<\/td>\n12<\/td>\n11<\/td>\n23<\/td>\n<\/tr>\n
\u00a0placebo<\/td>\n12<\/td>\n15<\/td>\n27<\/td>\n<\/tr>\n
\u00a0total<\/td>\n24<\/td>\n26<\/td>\n50<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

The result of analysis also indicated that there was no significant differences between the proportion of boy and girl neonates in two groups (p>0.05).\u00a0\u00a0 These results are presented in table 2.<\/p>\n

Table2 :\u00a0 Frequency distribution of the patients according to gender<\/strong><\/p>\n\n\n\n\n\n\n
treatment<\/strong><\/p>\n

gender<\/strong><\/td>\n

placebo<\/strong><\/td>\n\u00a0Manna of hedysarum extract<\/strong><\/td>\ntotal<\/strong><\/td>\n<\/tr>\n
\u00a0Girl<\/td>\n13<\/td>\n13<\/td>\n26<\/td>\n<\/tr>\n
\u00a0Boy<\/td>\n14<\/td>\n10<\/td>\n24<\/td>\n<\/tr>\n
\u00a0total<\/td>\n27<\/td>\n23<\/td>\n50<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Table 3 presents the mean value of bilirubin level of the two experiments and control group before the treatment. The result of independent t-test indicated that there was no significant differences between the bilirubin level of the experimental (Manna of hedysarum extract ) and the placebo (p>0.05).<\/p>\n

Table 3: comparing the mean values of bilirubin level of experimental and placebo group in pre test state<\/strong><\/p>\n\n\n\n\n\n
\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0index<\/strong><\/p>\n

treatment<\/strong><\/td>\n

\u00a0( mg\/dl)Mean<\/strong><\/td>\n\u00a0( mg\/dl)Standard Deviation<\/strong><\/td>\n<\/tr>\n
Placebo<\/td>\n6\/13<\/td>\n2\/1<\/td>\n<\/tr>\n
\u00a0Manna of hedysarum Extract<\/td>\n9\/13<\/td>\n2\/2<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

In table 4, the level of bilirubin in different times after the treatment is presented.\u00a0 Analysis of variance repeated measure was employed to examine the level of\u00a0 bilirubin following 24, 48 and 72 hour after the treatment by Manna of hedysarum extract and placebo.\u00a0 The results of analysis indicated that there was no significant difference between the two treatments after 24 hours, but the difference were significant after 48 and 72 hours of \u00a0treatment by \u00a0Manna of hedysarum compared to placebo (\u00a0 p=0.005 and p=0.0001). The level of bilirubin in the Manna of hedysarum treatment was significantly less that the treatment by the placebo.<\/p>\n

Table 4: The levels of\u00a0 bilirubin (mg\/dl) after 24, 48 and 72 hours following the treatment by \u00a0Manna of hedysarum and placebo<\/strong><\/p>\n\n\n\n\n\n
Time<\/strong><\/p>\n

treatment<\/strong><\/td>\n

( \u00a0(hr.24<\/strong><\/td>\n\u00a0 48 (hr.)<\/strong><\/td>\n\u00a072 (hr.)<\/strong><\/td>\n<\/tr>\n
\u00a0\u00a0placebo<\/td>\n\u00a0 15.6 \u00b1 3.3<\/td>\n\u00a016.3\u00b1 3.5<\/td>\n16.6\u00a0\u00a0 \u00a0\u00b1 \u00a03.5<\/td>\n<\/tr>\n
\u00a0Manna of hedysarum extract<\/td>\n14.8 \u00a0\u00b1 4.1<\/td>\n\u00a014.3\u00a0 \u00a0\u00b1 3.5 *<\/sup><\/td>\n12.7\u00a0 \u00a0\u00b1 \u00a03.5*<\/sup><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u03b1significant at a= <\/strong>0.05<\/p>\n

Table 5 presents the frequency of cases that needed hospitalization\u00a0 despite the treatment intervention in two groups.\u00a0 The result of chi squared test indicated that the proportion of the cases needing hospitalization was significantly larger in the placebo group (p=0.019).<\/p>\n

Table 5: Frequency distribution of patients in Manna of hedysarum and placebo treatment according to the need for hospitalization<\/strong><\/p>\n\n\n\n\n\n\n
\u00a0\u00a0\u00a0 treatment<\/strong><\/p>\n

hospitalized<\/strong><\/td>\n

Manna of hedysarum extract<\/strong><\/td>\nplacebo<\/strong><\/td>\ntotal<\/strong><\/td>\n<\/tr>\n
have<\/td>\n2<\/td>\n10<\/td>\n12<\/td>\n<\/tr>\n
\u00a0\u0627have not<\/td>\n21<\/td>\n17<\/td>\n38<\/td>\n<\/tr>\n
total<\/td>\n23<\/td>\n27<\/td>\n50<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Discussion and conclusion<\/strong><\/p>\n

Hyperbilirubinemia is one of the most common diseases of neonates and is one of the main concerns of mothers at the time of child birth.\u00a0 For this reason, research for findings treatment and medications that can decrease or eliminate this problem has been conducted by pediatricians. Many of the medications prescribed requires the hospitalization of the neonate that means the separation of the child from the mother.\u00a0\u00a0 New researches are adopting interventions that eliminate or minimize the separation period.\u00a0 It should be noted that hyperbilirubinemia is not the disease of today but rather it has been threatening the health of neonates from very old ages; a time that no hospital or modern way of treatments existed. \u00a0\u00a0It is a fact that plantar medication has been prescribed for treatment of many diseases and it is very likely that plantar medicine have also been used for treatment of \u00a0hyperbilirubinemia. Among the plantar medication, Manna of hedysarum is one of the most popular ones that have been used to treat different diseases.<\/p>\n

Tarhani (3) was one of the researcher who examined the effectiveness of Manna of hedysarum in addition to the application of phototherapy in hospitalized neonates that their bilirubin level exceeded 14 mg\/dg.\u00a0 The result of this research indicated that despite the fact that the level of bilirubin in the case group was less than the control group, however, there was no significant difference between the bilirubin level of the case and control neonates after 48 hours of treatment. Even the result of this research could show significant differences in favor of \u00a0Manna of hedysarum treatment, such intervention would not eliminate the separation problem that a mother is experiencing for leaving the neonate in the hospital.<\/p>\n

In regard to using plantar medicine for treatment of hyperbilirubinemia, Farhat ( \u00a0) conducted a research to examine the effectiveness of shirkhesht in hospitalized neonates and concluded that this medication had no significant effect on reducing the bilirubin level of neonate patients whereas in another research conducted by Ghotbi and associates (2006 ) opposite findings were reported for the effectiveness of this plantar medicine.\u00a0 Plantar medicine has been examined in treating jaundice in Turkey by Kagillian and associate (1992). These researchers used edible Agar to treat hyperbilirubinemia in neonates and reported that this medication had a significant effect on reducing the bilirubin level in neonate patients. \u00a0In regard to the findings of this research, no comparable results were reported in the related literature.\u00a0 The findings of this research showed that the plantar medication of Manna of hedysarum \u00a0\u00a0is effective in reducing the level of bilirubin while treating the neonates at home, eliminating the anxiety of separating the mother from her neonate in one hand and reducing the cost of hospitalization. \u00a0However, further research is needed before making firm suggestion to use this planter medication for outpatient or inpatient neonates suffering from hyperbilirubinemia.<\/p>\n

References<\/strong><\/p>\n

    \n
  1. Nelson Textbook of pediatrics. 19ed .\u00a0 international Edition, Elsevier\u00a0 2012: 603-6007<\/li>\n
  2. Gotbi, F. Nahidi. S, Zangi, M, assessing the effect of Shirkhest on reducing the bilirubin level of\u00a0 neonates , Research in Medicine,\u00a0 2006, No. 4 , 347-52<\/li>\n
  3. Tarhani, F.\u00a0 effect of oral Manna of hedysarum on reducing the billirubin level of physiologic jaundice in neonates, Qurterly Research Journal of Lorestan University of Medical Sciences, 2004, No. 23<\/li>\n
  4. Khoshdel A, Kheiri S. Effect of shir-e-khesht (billinaster drop) consumption by the neonates or their mothers on the neonatal icter. Journal of Shahrekord University of Medical Sciences (J Shahrekord Univ Med Sci) 2011; 13(4): 67-73.<\/li>\n
  5. Laghari AH, Ali Memon A, Memon S, Nelofar A, Khan KM, Yasmin A. Determination of free phenolic acids and antioxidant capacity of methanolic extracts obtained<\/li>\n
  6. from leaves and flowers of camel thorn (Alhagi maurorum). Nat Prod Res. 2012;26(2):173-6. Epub 2011 Aug 11. PubMed PMID: 21834635.<\/li>\n
  7. Shaker E, Mahmoud H, Mnaa S. Anti-inflammatory and anti-ulcer activity of the extract from Alhagi maurorum (camelthorn). Food Chem Toxicol. 2010 Oct;48(10):2785-90. Epub 2010 Jul 13. PubMed PMID: 20633591.<\/li>\n
  8. Ahmad S, Riaz N, Saleem M, Jabbar A, Nisar-Ur-Rehman, Ashraf M. Antioxidant flavonoids from Alhagi maurorum. J Asian Nat Prod Res. 2010 Feb;12(2):138-43. PubMed PMID: 20390757.<\/li>\n
  9. Atta AH, Abo EL-Sooud K. The antinociceptive effect of some Egyptian medicinal plant extracts. J Ethnopharmacol. 2004 Dec;95(2-3):235-8. PubMed PMID: 15507342.<\/li>\n
  10. Atta AH, Mouneir SM. Antidiarrhoeal activity of some Egyptian medicinal plant extracts. J Ethnopharmacol. 2004 Jun;92(2-3):303-9. PubMed PMID: 15138016.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    \u00a0Introduction Hyperbilirubinema is one of the common problems that cause […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[17],"tags":[],"class_list":["post-2756","post","type-post","status-publish","format-standard","hentry","category-vol6no2"],"_links":{"self":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/2756","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/comments?post=2756"}],"version-history":[{"count":5,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/2756\/revisions"}],"predecessor-version":[{"id":9103,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/2756\/revisions\/9103"}],"wp:attachment":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/media?parent=2756"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/categories?post=2756"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/tags?post=2756"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}