Prognostic value of biochemical liver parameters in neonatal sepsis‐associated cholestasis

Oswari, Hanifah; Widjaja, Ruth Karisma; Rohsiswatmo, Rinawati; Cleghorn, Geoffrey J.

doi:10.1111/jpc.12053

Cited by 16 publications

(16 citation statements)

References 19 publications

(38 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Prematurity is associated with altered oral absorption, and even lower drug clearance due to lower GFR and hepatic enzyme function . Clearance in newborns with hypoxic encephalopathy undergoing controlled hypothermia can be increased or decreased . Sepsis and complex surgery can result in impaired blood circulation as well as organ function with lower clearance …”

Section: Assessment Of Neonatal Exposurementioning

confidence: 99%

Drugs in lactation

Verstegen

Itô

2019

J of Obstet and Gynaecol

View full text Add to dashboard Cite

Although most medications can be taken safely during breastfeeding, potential risks of infant toxicity do exist because all medications will be excreted into the breast milk to some extent. The amount of medication excreted in the milk depends mainly on (i) within-drug variation, such as dosing; (ii) between-drug variation including chemical characteristics of the medication; and (iii) host factors, such as maternal pharmacokinetics (PK), including variations of pregnancy-associated changes and their post-partum recovery. Neonatal drug exposure is usually assessed by calculating an expected total infant daily dose through breast milk and comparing it to the normal therapeutic dose. However, clinical PK studies in this population are challenging to conduct. Recently, research methods using population PK analyses and physiologically-based PK modeling and simulation techniques have been recognized as a complementary approach to the conventional PK studies in this field. These efforts are important for rational risk assessment balancing the toxicity risk against the benefits of human milk. Health benefits of lactation for both mother and child are significant and a decision to withhold from this should not be taken lightly. In case limited information is present, additional expertise from pharmacists or clinical pharmacologist with expertise in this area should be sought.

show abstract

Section: Assessment Of Neonatal Exposurementioning

confidence: 99%

Drugs in lactation

Verstegen

Itô

2019

J of Obstet and Gynaecol

View full text Add to dashboard Cite

show abstract

“…(18) Serum GGT levels have been found to be of prognostic importance in other pediatric cholestatic diseases, including biliary atresia, (19) total parenteral nutrition-related cholestasis, (20) idiopathic neonatal hepatitis, (21,22) and neonatal sepsis-related aRtiCle inFoRmation: cholestasis. (23) Elevated serum GGT is the most consistent biochemical abnormality in pediatric patients with PSC, and it appears to be a more sensitive indicator for bile duct injury in PSC compared with ALP and bilirubin. (24)(25)(26)(27)(28)(29)(30)(31) GGT at diagnosis of PSC in children correlates with long-term outcomes, but ALP does not.…”

mentioning

confidence: 99%

“…Because the serum ALP levels widely fluctuate in children due to bone growth, serum gamma glutamyltransferase (GGT) is used commonly in children as a marker for cholestasis . Serum GGT levels have been found to be of prognostic importance in other pediatric cholestatic diseases, including biliary atresia, total parenteral nutrition‐related cholestasis, idiopathic neonatal hepatitis, and neonatal sepsis‐related cholestasis . Elevated serum GGT is the most consistent biochemical abnormality in pediatric patients with PSC, and it appears to be a more sensitive indicator for bile duct injury in PSC compared with ALP and bilirubin .…”

mentioning

confidence: 99%

Gamma Glutamyltransferase Reduction Is Associated With Favorable Outcomes in Pediatric Primary Sclerosing Cholangitis

Deneau

Mack

Abdou

et al. 2018

Hepatology Communications

View full text Add to dashboard Cite

Adverse clinical events in primary sclerosing cholangitis (PSC) happen too slowly to capture during clinical trials. Surrogate endpoints are needed, but no such validated endpoints exist for children with PSC. We evaluated the association between gamma glutamyltransferase (GGT) reduction and long‐term outcomes in pediatric PSC patients. We evaluated GGT normalization (< 50 IU/L) at 1 year among a multicenter cohort of children with PSC who did or did not receive treatment with ursodeoxycholic acid (UDCA). We compared rates of event‐free survival (no portal hypertensive or biliary complications, cholangiocarcinoma, liver transplantation, or liver‐related death) at 5 years. Of the 287 children, mean age of 11.4 years old, UDCA was used in 81% at a mean dose of 17 mg/kg/day. Treated and untreated groups had similar GGT at diagnosis (314 versus 300, P= not significant [NS]). The mean GGT was reduced at 1 year in both groups, with lower values seen in treated (versus untreated) patients (99 versus 175, P= 0.002), but 5‐year event‐free survival was similar (74% versus 77%, P= NS). In patients with GGT normalization (versus no normalization) by 1 year, regardless of UDCA treatment status, 5‐year event‐free survival was better (91% versus 67%, P< 0.001). Similarly, larger reduction in GGT over 1 year (> 75% versus < 25% reduction) was also associated with improved outcome (5‐year event‐free survival 88% versus 61%, P= 0.005). Conclusion:A GGT < 50 and/or GGT reduction of > 75% by 1 year after PSC diagnosis predicts favorable 5‐year outcomes in children. GGT has promise as a potential surrogate endpoint in future clinical trials for pediatric PSC.

show abstract

“…Oswari et al evaluated the prognostic value of bilirubin, AST, ALT, and GGT and reported that only AST and GGT had prognostic value to predict the outcomes of SAC patients. 17 The prognosis of the two groups in our study did not differ significantly, although the initial liver function parameters were different.…”

Section: Discussionmentioning

confidence: 70%

“…19 Oswari et al reported that improvement and resolution of cholestasis occurred on the 19 th day after the onset of sepsis. 17 Administration of UDCA for only 7 days might not have allowed time for cholestasis resolution.…”

Section: Discussionmentioning

confidence: 99%