Original Article Abstract Introduction: Hyperbilirubinemia is a common problem in the neonatal period. Phototherapy is the most important proposed treatments for hyperbilirubinemia, but several drugs along with phototherapy are used with recent advances. Aim: To see the effect of oral fenofibrate on serum bilirubin level in term neonates with unconjugated hyperbilirubinaemia. Methods: This prospective study was carried out in Combined Military Hospital Cumilla from July 2018 to June 2019. Total 60 term and normal birth weight neonates with neonatal jaundice were enrolled in this study. Jaundiced newborns presenting with infection, G6PD deficiency, conjugated bilirubin >2 mg/dl or >15% of total serum bilirubin (TSB) and congenital anomalies were excluded from this study. These neonates were randomly allocated to the Fenofibrate group (30 cases) and Control group (30 cases). Total serum bilirubin was measured every 24 hours till the end of phototherapy and at the time of discharge. Statistical analysis was done using SPSS 22.0 and p<0.05 was considered significant. Results: There were no significant differences in gender, age, weight, gestational age and type of delivery between two groups. Mean duration of hospital stay were 4.0±0.7 and 5.5±1.4 days in Fenofibrate group and Control group respectively (p<0.001). In Fenofibrate group, TSB was decreased from 17.2 mg/dl to 15.2 mg/dl after 24 hours, to 13.6 mg/dl after 48 hours, and to 10.1 mg/dl at the time of discharge. In control group, TSB was decreased from 17.0 mg/dl to 16.3 mg/dl after 24 hours, to 15.9 mg/dl after 48 hours, and to 10.3 mg/dl at the time of discharge. Conclusion: Treatment of neonatal unconjugated hyper- bilirubinemia with fenofibrate reduces neonatal bilirubin levels faster and decreases the need for phototherapy and hospitalization. Key-words: Bilirubin, Hyperbilirubinemia, Fenofibrate, Jaundice, Neonate, Phototherapy. Introduction Hyperbilirubinemia is one of the most prevalent clinical conditions in neonates 1 especially in the first week of life, nearly 5-25% of neonates develop hyperbilirubinemia 2,3 . Jaundice is a yellowish discoloration of the skin and sclera. It is an important symptom of elevated serum bilirubin, which is caused by an abnormality of bilirubin metabolism or excretion. The bilirubin can be either conjugated or unconjugated. Conjugated bilirubin is water-soluble and is excreted into the bile to be cleared from the body. Unconjugated bilirubin is a waste product of hemoglobin breakdown that is taken up by the liver, where it is converted by the enzyme uridine diphosphoglucuronate glucuronosyltransferase (UGT) into conjugated bilirubin 4 . Hyperbilirubinemia in children is usually unconjugated. It is usually caused by problems with red blood cell stability and survival or by defects in the bilirubin conjugating enzyme, UGT. In contrast, disorders that result in conjugated hyperbilirubinemia are usually caused by intrinsic liver dysfunction. However, some diseases cause both unconjugated and conjugated hyperbilirubinemia because they affect several different aspects of hepatocyte function 4 . Severe hyperbilirubinemia (total serum bilirubin [TSB] level of more than 20 mg/dl) occurs in less than 2% in term infants and can lead to kernicterus (i.e., chronic bilirubin encephalopathy) and permanent neurodevelopmental delay 5 . Therefore, it is important to systematically evaluate all infants for hyperbilirubinemia. There are different pharmacological and non-pharmacological modalities for the treatment of hyperbilirubinemia. Phototherapy is the most widely used non-pharmacological therapy, but it has several unexpected complications such as deleterious effect to eyes, high temperature, loose stool and bronze baby syndrome 6 . Phenobarbitone, metalloporphyrins and D-penicillamine are the pharmacological agents used for the treatment of unconjugated neonatal jaundice. But they are not very effective and safe in clinical use 7 . Fibrates, used as a hypolipidemic drug 8 also increase bilirubin conjugation and excretion via induction of glucuronyltransferase activity 9 . Potency to induce bilirubin conjugation is many times more in fibrates than phenobarbitone 10 . The effect of clofibrate on uncomplicated hyperbilirubinemia was proposed in some studies 11 but no longer routinely used for hyperlipidemia in adults due to its adverse effect profile. Fenofibrate is now the most widely used fibrate in treating hyperlipidemia and has a comparatively much better safety profile than clofibrate 12 . This study is designed to assess the effect of Mosharref M 1 , Rehnuma N 2 , Jahan N 3 , Zafreen F 4 Effect of Oral Fenoϐibrate on Serum Bilirubin Level in Term Neonates with Unconjugated Hyperbilirubinaemia: A Randomized Control Trial 1. Lt Col Murshida Mosharref, MBBS, DCH, FCPS, Classified Child Specialist, Combined Military Hospital (CMH), Ghatail (E-mail : murshida974@gmail.com) 2. Lt Col Naila Rehnuma, MBBS, FCPS Graded Child Specialist, CMH, Ghatail. 3. Maj Nusrat Jahan, MBBS, Graded Child Specialist, CMH, Ghatail. 4. Dr Farzana Zafreen, MBBS, MPH, Associate Professor & Head, Department of Community Medicine, Medical College for Women & Hospital, Uttara, Dhaka. DOI: https://doi.org/10.3329/jafmc.v16i1.53843 35 JAFMC Bangladesh. Vol 16, No 1 (June) 2020