in the first day of life , bilirubin production is increased to an estimated average of 8 to 10 mg / kg of body weight per day , an amount about two or three times greater than that of adults . phototherapy is the most widely used form of therapy for the treatment and prophylaxis of neonatal hyperbilirubinemia . several potential complications may occur with the use of phototherapy , such as retinal degeneration , fluid imbalance , and bronze baby syndrome . some reports have demonstrated that home phototherapy may be an effective and safe alternative to prolonged hospitalization for healthy full - term neonates with jaundice . clear advantages of home - centered phototherapy include : ( 1 ) reduced coast ; ( 2 ) avoidance of parent - infant separation ; and ( 3 ) parental satisfaction . although some pharmacological agents such as activated charcoal or agar are suggested to treat neonatal jaundice , further study of this type of therapy is needed before to their routine clinical use . mohammadzadeh et al studied the effect of clofibrate on reducing serum bilirubin of neonates beyond the first week of life . badeli and colleagues determined the effect of clofibrate on uncomplicated hyperbilirubinemia of neonates during the first week of life . the aim of the present study was determination the effect of 50 mg / kg of clofibrate on tsb of hyperbilirubinemia of neonates under home phototherapy . from april 4 , 2007 to june 20 , 2008 60 neonates with uncomplicated hyperbilirubinemia who were under home phototherapy in rasht , iran , entered our study . inclusion criteria were body weight between 25004000 grams with gestational age 38 to 41 weeks , breastfed , and having total serum bilirubin ( tsb ) between 14 to 20 mg / dl , with postnatal age above 72 hours . infants with abo or rh incompatibility , g6pd deficiency , and conjugated hyperbilirubinemia or any concomitant disease were excluded . portable phototherapy units consist of 4 special blue tubes placed 40 cm above the infant as home phototherapy . patients were examined and a sample of serum bilirubin was taken daily . the neonates ( n=60 ) were randomly divided into two groups and they were matched regarding weight , sex , age and value of the first tsb . 30 neonates were allocated to clofibrate group ( group i ) and 30 neonates to control group ( group ii ) . clofibrate group ( group i ) was given a single dose of 50 mg / kg clofibrate before starting phototherapy . in the first day , laboratory tests included estimation of total bilirubin ( direct and indirect ) , blood group including rh of the mother and neonate , complete blood count ( cbc ) , g6pd activity , coombs test , reticulocyte count . direct and indirect , as well as tsb were measured every 24 hours by the same laboratory till tsb dropped under 10 mg / dl . data were analyzed using spss 10 ; t - test and anova were used for analyzing the data . among 60 neonates , 30 infants consisting of 18 ( 60% ) females and 12 ( 40% ) males belonged to group i ( clofibrate ) and 17 ( 56.7% ) females and 13 ( 43.3% ) males to group ii ( control ) . there were no statistically significant differences between the two groups regarding weight , age and first tsb value ( table 1 ) . tbs values show significant difference between the two groups 24 and 48 hours after starting phototherapy at home . mean ( sd ) phototherapy time in group i was 72(0.0 ) hours and in group ii 76.80 ( 9.76 ) hours . mean ( sd ) age , weight and first tsb- value in the two groups sd : standard deviation tsb : total serum bilirubin comparison of mean total serum bilirubin ( mg / dl ) after 24 and 48 hours of phototherapy in the two groups the duration of phototherapy was significantly shorter in clofibrate group ( p<0.001 ) . all neonates in group i needed phototherapy still after 72 hours but in group ii 24 ( 80% ) neonates had to receive phototherapy for 72 and 6 ( 20% ) for 96 hours . serum bilirubin levels after physician 's examining were measured at beginning and 24 , 48 hours after phototherapy . bilirubin of both groups was measured in the same laboratory . on serial daily examination during phototherapy and up to 2 days after that no problems or side effects were observed . also for a period of two months in this clinical trial study we determined the effect of lower dose ( 50 mg / kg ) of clofibrate on neonatal hyperbilirubinemia in term neonates under home phototherapy . in the present study we demonstrated that in clofibrate group there was lower tsb after 24 and 48 hours home phototherapy compared with control group . also the neonates in group i needed to receive shorter phototherapy than those in group ii . although there are advantages of home phototherapy , several potential complications may occur with its use . at present there is no safe drug for treatment of neonatal icterus and shortening of phototherapy time . metalloporphyrins and d - penicillamine act by inhibition of heme oxygenase , agar and charcoal by decreasing entrohepatic circulation . the clofibrate and phenobarbital are potent inducers of microsomal enzymes that increase bilirubin conjugation and excretion . clofibrate like phenobarbital is a hepatic bilirubin metabolism inducer , in addition causes 100% increase of hepatic bilirubin clearance within 6 hours with no drowsiness effect in contrast to the latter . clofibrate when used as an antilipidemic agent in adults , has some side effects such as nausea , gastrointestinal disturbance , vomiting and loose stools . none of these side effects were reported in neonates with a single dose of clofibrate[15 , 16 ] . like phenobarbital , clofibrate increases bilirubin conjugation and excretion and is a better enhancer of glucuronosyl transferase induction causing 100% increase of hepatic bilirubin clearance within 6 hours , sooner than phenobarbital . phenobarbital also causes drowsiness in neonates and may slow down the oxidation of bilirubin in the brain leading to worse bilirubin toxicity . although we detected in our studies no side effects in infants with a single dose of clofibrate , determination of minimum and effective dose would be important . this study demonstrated that a single dose of clofibrate ( 50mg / kg ) significantly reduces indirect hyperbilirubinemia in healthy breastfed term newborns with home - based phototherapy . this result is similar to the studies of mohammadzadeh et al and badeli et al , noting that they used 100 mg / kg of the drug in hospitalized patients . our study demonstrated that lower dose of clofibrate is effective on neonatal hyperbili - rubinemia receiving home phototherapy as well . he found significant reduction in bilirubinemia at 16 hours and decrease in the intensity and duration of jaundice and also phototherapy requirement . lindenbaum showed significant reduction 16 hours after treatment with clofibrate in tsb of 47 neonates . other studies in iran and france confirmed the beneficial effect of clofibrate for reducing of tsb in babies with no risk factor for hemolysis . in conformity with those previous studies , we did not detect any untoward complications during therapy and after two months follow up . twenty mothers discontinued home phototherapy because of their own concern or others ' comments ; they were excluded of the study . this study suggests that a lower dose of clofibrate is effective in outpatients with neonatal hyperbilirubinemia under home phototherapy . further studies are needed for approved routine use of this drug in non - hemolytic hyperbilirubinemia of healthy term inewborns as outpatients .