Zinc sulfate on neonatal hyperbilirubinemia: an updated systematic review and meta-analysis

de Oliveira H.M.; Gallo Ruelas M.; Barbosa L.M.; Diaz C.A.V.; Wegner G.R.M.; Wegner B.F.M.; da Cruz A.V. · European Journal of Pediatrics (2025) · DOI: 10.1007/s00431-024-05917-5

Resumen

Neonatal hyperbilirubinemia is a prevalent condition, with a risk of serious complications. Phototherapy is the standard treatment for significant cases, but its limitations highlight the need for additional options. Zinc sulfate has emerged as a potential adjunctive treatment. Our objective is to evaluate the efficacy of zinc sulfate as an adjunct to phototherapy in neonates with hyperbilirubinemia. PubMed, Embase, and CENTRAL were searched for studies published up to September 2024. Eligible studies were randomized clinical trials (RCTs) enrolling neonates with hyperbilirubinemia that evaluated the combined use of phototherapy and zinc sulfate. This study followed PRISMA guidelines, with independent extraction of data by two reviewers. Risk of bias was assessed using the RoB2 tool, and the quality of evidence was evaluated using the GRADE approach. Eleven RCTs comprising 1,349 neonates were included. A total of 690 (51.1%) neonates received zinc sulfate. Zinc sulfate significantly reduced bilirubin levels at 24 h (MD = -0.76 mg/dL; 95% CI = -1.30 to -0.22; P <.01; I2 = 82%), 48 h (MD = -0.88 mg/dL; 95% CI = -1.60 to -0.17; P = 0.02; I2 = 76%) and at 72 h (MD = -1.19 mg/dL; 95% CI = -2.29 to -0.09; P =.003; I2 = 94%). Subgroup analysis indicated that term neonates with normal birth weight benefited most from the intervention, while preterm and low-birth-weight infants showed no significant difference. Conclusion: Zinc sulfate effectively reduces serum bilirubin levels in neonates with hyperbilirubinemia when used alongside phototherapy, especially in term neonates. Trial registration number and date of registration: PROSPERO, CRD42024586259, 09/13/2024. The Impact of Zinc Sulfate on the Treatment of Neonatal Hyperbilirubinemia: An Updated Systematic Review and Meta-Analysis”; CRD42024586259; Link: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=586259 © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024.