Effect of ursodeoxycholic acid on indirect hyperbilirubinemia in neonates treated with phototherapy

Kafory, EmanEl-Sayed Al; El-Gendy, FadyM; Bahbah, WaelA

doi:10.4103/mmj.mmj_885_17

Cited by 8 publications

(4 citation statements)

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“…The induction of intestinal UGT1A1 expression, reduction of absorption of bile acid from the intestine and subsequent reduction of enterohepatic circulation, and anti-apoptotic and antioxidant effects are the main mechanisms justifying the therapeutic effect of UDCA on IHB (58). Honar et al revealed that UDCA could reduce the duration of phototherapy, the hospitalization period, and the mean TSB in the intervention group, consistent with the results of other trials (58)(59)(60)(61)(62)(63)(64). Two systematic reviews demonstrated the efficacy of UDCA in neonatal IHB (65,66).…”

Section: Ursodeoxycholic Acidsupporting

confidence: 56%

Recent Advances in Adjuvant Pharmacotherapy for Neonatal Indirect Hyperbilirubinemia: A Narrative Review

Nouri

Zarkesh

2023

J Compr Ped

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Context: Hyperbilirubinemia is a common cause for diagnostic work-up and therapeutic intervention in neonates and needs a convenient, quick, and safe treatment modality. Phototherapy is the most common treatment for neonatal jaundice; however, complementary treatment is still needed. Despite the identification of the enzymatic pathways of bilirubin catabolism, few pharmacological interventions have been found to be effective in reducing bilirubin, along with traditional phototherapy. This review was conducted to evaluate recent pharmacotherapies as adjuvants to phototherapy for the treatment of neonatal indirect hyperbilirubinemia (IHB). Evidence Acquisition: This study was carried out through a literature search with the keywords of Infant, Newborn, and Indirect Hyperbilirubinemia, combined with Drug Therapy, in PubMed, Scopus, International Statistical Institute, Web of Science, Cochrane, and Embase databases. This study included relevant articles (i.e., randomized controlled trials, observational studies, guidelines, and reviews) written in English and published between 2012 - 2022. Results: This narrative review first assessed the relevant articles to define IHB and its etiology. Then, the efficacy and side effects of recent pharmacologic agents as adjuvants to phototherapy were discussed. Additionally, this study reviewed the efficacy and safety of drugs prescribed to neonates to prevent jaundice. Conclusions: The best drug for adjuvant pharmacotherapy, in addition to phototherapy, for neonatal jaundice has not still been identified. The use of probiotics, prebiotics, synbiotics, and ursodeoxycholic acid (UDCA) in adjuvant to phototherapy has been recently increasing, and beneficial results were observed in most studies. The use of agar, charcoal, fibrate, and phenobarbital had a minor therapeutic role in recent years. There were conflicting results about the efficacy of herbal agents in neonatal jaundice. The use of intravenous immunoglobulin (IVIG), metalloporphyrin, and albumin is also limited to severe or immune-related IHB cases. The prescription of the aforementioned drugs sometimes had different results. Therefore, further research in this regard is necessary.

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Section: Ursodeoxycholic Acidsupporting

confidence: 56%

Recent Advances in Adjuvant Pharmacotherapy for Neonatal Indirect Hyperbilirubinemia: A Narrative Review

Nouri

Zarkesh

2023

J Compr Ped

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“…In the study by El-Gendy et al, duration of phototherapy was significantly shorter among neonates who received UDCA treatment (6).…”

Section: Key Pointmentioning

confidence: 90%

“…Furthermore, the dose of UDCA was different between studies (11). Most of the studies published were conducted in Middle East region (6,11), therefore larger studies from different geographical region and more sample size are recommended.…”

Section: Key Pointmentioning

confidence: 99%

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Ursodeoxycholic acid and phototherapy versus phototherapy and placebo on neonatal indirect hyperbilirubinemia

et al. 2023

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Introduction: Recently ursodeoxycholic acid was recommended for the treatment of neonatal hyperbilirubinemia in a few studies. Objectives: This study aimed to compare ursodeoxycholic acid and phototherapy versus phototherapy in lowering the level of bilirubin in neonates who was admitted due to hyperbilirubinemia. Patients and Methods: This randomized double-blind study was carried out in the department of neonatology at the children’s medical center of Ahvaz Jundishapur of the University of Medical Sciences. Inclusion criteria were weight 2500-4200 g and exclusive breastfeeding. Gestational age between 38-41 weeks and age between 3-7 days were included. Total bilirubin between 14-20 according to Bhutani nomogram and direct bilirubin was less than 2 mg/dl was included. Exclusion criteria were ABO incompatibility, Rh incompatibility, G6PD (glucose6-phosphate dehydrogenase) deficiency, sepsis, hypothyroidism, liver problem, prematurity and newborn of diabetic mothers. A dose of 5 mg/kg per dose of ursodeoxycholic acid (UDCA) was prescribed for neonates every 12 hours. Placebo is also prescribed for other neonates. Unconjugated bilirubin was measured after 4 hours and every 12 hours till total bilirubin=12 mg/dL. The primary outcome measures were total bilirubin level four hours and every 12 hours after admission till reached 12 mg/dL. The secondary outcome measure was total bilirubin=12 mg/dL at 12-24 hours after admission and diarrhea, vomiting, skin rash or any adverse effect in the neonates who received UDCA. Neonates who underwent phototherapy and UDCA were the case group. Neonates who received phototherapy and placebo were allocated in the control group. Data were analyzed using SPSS version 16.0. Kolmogorov-Smirnov test was conducted to evaluate data distribution. Intention-to-treat analysis was used. Mann-Whitney U test was conducted for data analysis. Results: In the current study, 30 cases and 30 control were included. Discharged neonates were 96% among the UDCA group and 87% among the control group in the 1st 24 hours after admission. Among the UDCA group, 100% were discharged at the 2nd 24 hours of admission and 96% among the control. The duration of phototherapy was shorter in the case group than in the control group, however this difference had no statistical difference. Conclusion: No significant difference between neonates who underwent phototherapy and phototherapy+ UDCA in terms of duration of phototherapy and bilirubin reduction was found. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trials (identifier: IRCT20181003041225N1; https://en.irct.ir/trial/34272, ethical code; IR.AJUMS.REC.1397.899).

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Ursodeoxycholic acid as adjuvant treatment to phototherapy for neonatal hyperbilirubinemia: a systematic review and meta-analysis

et al. 2022

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Background Neonatal hyperbilirubinemia is observed in most newborns, and 5–15% of neonates require phototherapy. Phototherapy is effective but often prolongs hospitalization and has both short-term and potential long-term harms. The aim of this systematic review and meta-analysis was to evaluate the role of ursodeoxycholic acid (UDCA) combined with phototherapy in neonatal hyperbilirubinemia. Methods A literature search was conducted on September 1, 2021; 590 studies were screened, and 17 full texts were assessed by two authors. We included randomized controlled trials with or without placebo intervention. Primary outcomes were changes in total bilirubin levels at 24 hours and phototherapy duration. We calculated mean differences with 95% confidence intervals (CI). Results Six studies with 880 neonates were included. Of these studies, only two used a placebo-controlled double-blinded design. The overall risk of bias was high in one and moderate in four of the included studies. The mean decrease in the total bilirubin level during the first 24 hours was 2.06 mg/dL (95% CI 0.82–3.30; six studies) greater in the UDCA treatment group. The phototherapy duration was 19.7 hours (95% CI 10.4–29.1; five studies) shorter in the UDCA treatment group. Conclusions We found low-quality evidence that UDCA as an adjuvant to phototherapy seems to decrease total bilirubin faster and shorten phototherapy duration compared to standard treatment. Further studies are needed to confirm the efficacy, acute and long-term outcomes, and safety before implementing UDCA as an adjuvant to phototherapy in neonatal hyperbilirubinemia.

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Effect of ursodeoxycholic acid on indirect hyperbilirubinemia in neonates treated with phototherapy

Cited by 8 publications

References 1 publication

Recent Advances in Adjuvant Pharmacotherapy for Neonatal Indirect Hyperbilirubinemia: A Narrative Review

Recent Advances in Adjuvant Pharmacotherapy for Neonatal Indirect Hyperbilirubinemia: A Narrative Review

Ursodeoxycholic acid and phototherapy versus phototherapy and placebo on neonatal indirect hyperbilirubinemia

Ursodeoxycholic acid as adjuvant treatment to phototherapy for neonatal hyperbilirubinemia: a systematic review and meta-analysis

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