A Systematic Review and Meta-Analysis on the Effect of Cotoneaster manna on Neonatal Jaundice

Background & Aim: The manna of Cotoneaster nummularia (purgative manna) has been traditionally used in the Persian medicine for the treatment of neonatal jaundice. The effect of Cotoneaster manna on neonatal jaundice was investigated with systematic review and metaanalysis. Experimental: This study intended to explore the clinical trials of the efficacy of Cotoneaster manna on neonatal jaundice. The aspects considered in this study included searching for relevant English and Persian data bases up to March 2016. The methodological quality was assessed using the Consort checklist for herbal interventions. Seven studies with low or moderate risk of bias involved 804 participants of which 410 cases versus 394 controls were selected for systematic review and meta-analysis with CMA software version 2.2. Results: Total plasma bilirubin in 0, 12, 24, 36, 48 hours and the duration of hospital stay were checked and no adverse effect was reported. The Meta-analysis exhibited marked heterogeneity of the results (Q-value = 132.446, P< 0.0001, I2 = 87.165, τ = 0.998). However, it showed favorable effect of Cotoneaster manna on reducing neonatal jaundice (n= 804, or = 0.242, 95% CI: 0.147 to 0.399, P< 0.0001). Also it was effective on reducing duration of hospital stay (n= 804, SMD= -1.154, 95% CI: -1.854 to -0.455, P< 0.001). However, the results obtained were heterogeneous (Qvalue= 119.642, P< 0.0001, I2= 94.985, τ= 0.913). Recommended applications/ industries: Although the meta-analysis of Cotoneaster manna showed positive effect on treatment of neonatal jaundice in these studies, it is warranted to carry out further multi-centre randomized clinical trials with larger samples and controlled risk factors, alongside comparison with phototherapy.