Abstract

Introduction: Hyperbilirubinemia is a common benign problem in neonates, however in some circumstances; it may cause bilirubin induced neurological dysfunction. Although phototherapy remains the mainstay of treatment for neonatal jaundice, it has some side effects.

Aim: The aim of this study was to assess the additive effect of Ursodeoxycholic Acid (UDCA) in reducing indirect hyperbilirubinemia in neonates under phototherapy.

Patients and Methods: This randomized controlled study was performed on 100 newborn with indirect hyperbilirubinemia divided into two groups. Group A: included 50 neonates, received Ursodeoxycholic Acid orally in addition to phototherapy. Group B: included 50 neonates, received phototherapy only. All patients were subjected to detailed history taking, thorough clinical examination and laboratory investigations. Total serum bilirubin (TSB) and direct bilirubin were measured on admission and followed up every 12 hours (h) till serum bilirubin became below 10 mg/dl.

Results: The sex, mean age and weight, onset of jaundice and total serum bilirubin at the time of admission were comparable in both groups (P > 0.05). The mean TSB measured at 12h, 24h, 36h and 48h of phototherapy in group A was 13.82 ± 1.11, 11.94 ± 1.60, 10.66 ± 1.52, 9.48 ± 1.33 mg/dl respectively and in group B was 15.15 ± 1.41 at 12h, 13.70 ± 1.25 at 24h, 12.49 ± 1.25 at 36h, 11.47 ± 1.13 at 48h. The TSB levels were significantly lower in the group who received UDCA and phototherapy (P < 0.05). The mean duration under phototherapy till reaching TSB < 10 mg/dl in group A (42.96h) were significantly lower than that in group B (71.52 h) (P < 0.0001).

Conclusion: UDCA is considered an effective and safe complementary therapeutic adjuvant in neonatal indirect hyperbilirubinemia.

Keywords: Hyperbilirubinemia; Jaundice; Neonates; Phototherapy; Ursodeoxycholic Acid

References

1. Ullah S., et al. “Hyperbilirubinemia in neonates: types, causes, clinical examinations, preventive measures and treatments: a narrative review article”. Iranian Journal of Public Health5 (2016): 558-568.
2. Campistol J., et al. “Neurological dysfunction induced by bilirubin”. Neurologia (English Edition) 27.4 (2012): 202-211.
3. Wood AJJ., et al. “Neonatal Hyperbilirubinemia”. New England Journal of Medicine8 (2001): 581-590.
4. Xiong T., et al. “The side effects of phototherapy for neonatal jaundice: what do we know? What should we do?” European Journal of Pediatrics 10 (2011): 1247-1255.
5. Ezzeldin Z., et al. “The effect of hat on phototherapy-induced hypocalcemia in jaundiced full-term neonates”. Research and Reports in Neonatology 5 (2015): 73-78.
6. Ip S., et al. “An evidence-based review of important issues concerning neonatal hyperbilirubinemia”. Pediatrics1 (2004): 130-153.
7. Bhutani VK., et al. “Hyperbilirubinemia in Preterm Neonates”. Clinics in Perinatology2 (2016): 215-232.
8. Ahadi A., et al. “Comparison of the efficacy of Clofibrate with Phenobarbital in decreasing neonatal hyperbilirubinemia”. Iranian Journal of Neonatology3 (2013): 13-19.
9. Bhatia V., et al. “Management of neonatal cholestasis: consensus statement of the Pediatric Gastroenterology Chapter of Indian Academy of Pediatrics”. Indian Pediatrics3 (2014): 203-210.
10. Honar N., et al. “Effect of Ursodeoxycholic acid on indirect hyperbilirubinemia in neonates treated with phototherapy”. Journal of Pediatric Gastroenterology and Nutrition1 (2016): 97-100.
11. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Pediatrics1 (2004): 297-316.
12. Hassan AM., et al. “Effect of Ursodeoxycholic acid in lowering neonatal indirect hyperbilirubinemia: a randomized controlled trial”. Merit Research Journal of Medicine and Medical Sciences 9 (2015): 402-405.
13. Bondarenko LB., et al. “Promising new fixed combination for the treatment of diseases of the hepatobiliar system: Substantiation of pharmacotherapeutic properties and pharmaceutical quality profile”. Regulatory Mechanisms in Biosystems9 (2018): 345-360.
14. Palmela I., et al. “Hydrophilic bile acids protect human blood-brain barrier endothelial cells from disruption by unconjugated bilirubin: an in vitro study”. Frontiers in Neuroscience80 (2015): 102-114.
15. Shahramian I., et al. “Therapeutic Effects of Ursodeoxycholic Acid in Neonatal Indirect Hyperbilirubinemia: A Randomized Double-blind Clinical Trial”. Archives of Anesthesiology and Critical Care3 (2019): 99-103.
16. Jafari S., et al. “Role of ursodeoxycholic acid in neonates with indirect hyperbilirubinemia-an open labelled randomised control trial”. International Journal of Contemporary Pediatric2 (2018): 432-435.

Citation

Citation: Haidy Mohammed Zakaria., et al. “Role of Ursodeoxycholic Acid in Lowering Indirect Hyperbilirubinemia in Neonates Under Phototherapy". Acta Scientific Gastrointestinal Disorders 3.10 (2020): 07-11.

Copyright

Copyright: © 2020 Haidy Mohammed Zakaria., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.