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Zarkesh M, Mahdipour S, Aghili S, Jafari A, Nouri SAH, Hassanzadeh Rad A, Ghalandari M, Tabrizi M. Evaluation of therapeutic effect of oral Ursodeoxycholic Acid on indirect hyperbilirubinemia in term neonates undergoing phototherapy: A randomized controlled clinical trial. PLoS One 2023; 18:e0273516. [PMID: 38085723 PMCID: PMC10715657 DOI: 10.1371/journal.pone.0273516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/03/2022] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION AND AIMS Phototherapy is the most common treatment modality of neonatal hyperbilirubinemia. We aimed to evaluate the therapeutic effect of oral Ursodeoxycholic Acid (UDCA) on indirect hyperbilirubinemia in term neonates undergoing phototherapy. MATERIALS AND METHODS This randomized controlled clinical trial was performed on 106 full-term neonates with jaundice who were admitted to the neonatal ward of 17 Shahrivar Hospital in Rasht, Iran. The neonates were randomly assigned to two groups of intervention (10 mg/kg UDCA+phototherapy) and control (phototherapy alone). Total serum bilirubin (TSB) was measured at the time of admission, during first 12, 24, and 48 hours after admission and at the time of discharge. The duration of hospitalization and side effects were also assessed in both groups. IBM SPSS Statistics for Windows, version 20 was used to analyze the data. RESULTS Results showed that in the intervention group, 28 (52.8%) of neonates were boys with the mean age of 5.1±1.25 days. While, in the control group 29 (54.7%) of them were boys with the mean age of 5.19±2.26 days. Bilirubin levels in both groups decreased significantly after hospitalization (at 12, 24 and 48 hours) (P <0.001). The mean of bilirubin at 12, 24 and 48 hours in the intervention and control groups were 17.1, 13.2, 10.2 mg / dl and 17.1, 14.2 and 11.3 mg / dl, respectively. At the time of discharge, TSB in the former compared to the latter group was significantly reduced (7.74± 1.39 vs. 8.67±1.35) (P = 0.001). In addition, the duration of hospitalization was considerably shorter in the intervention compared to the control group (P = 0.038) and no side effects were observed. CONCLUSIONS Administering UDCA plus phototherapy reduced TSB and length of hospital stay with proper safety and efficacy. Therefore, it seems that this combination can be an appropriate treatment modality in neonatal hyperbilirubinemia.
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Affiliation(s)
- Marjaneh Zarkesh
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Sadroddin Mahdipour
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Safoora Aghili
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Atefeh Jafari
- Department of Clinical Pharmacy, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Afagh Hassanzadeh Rad
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Ghalandari
- PhD Student in Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Manijeh Tabrizi
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Božić D, Tonkić A, Vukojevic K, Radman M. A Case Report: Idiopathic or Drug-Induced Autoimmune Hepatitis-Can We Draw a Line? Clin Pract 2023; 13:1393-1399. [PMID: 37987426 PMCID: PMC10660691 DOI: 10.3390/clinpract13060125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
Idiosyncratic drug-induced liver injury (DILI) is an unpredictable reaction of individuals exposed to a certain drug, and drug-induced autoimmune hepatitis (DIAIH) presents a DILI phenotype that mimics idiopathic autoimmune hepatitis (AIH) when considering the clinical, biochemical, serological and histological parameters. We present a case report of a 48-year-old male who was hospitalized due to severe hepatocellular liver injury two months after self-treatment with a muscle-building dietary supplement based on arginine-alpha-ketoglutarate, L-citrulline, L tyrosine, creatine malate and beet extract. His immunology panel was positive with increased IgG levels, and radiologic methods showed no signs of chronic liver disease. He underwent corticosteroid treatment with adequate response. After therapy withdrawal, a clinical relapse occurred. Seven months after the initial presentation, liver MR suggested initial cirrhotic changes in the right liver lobe. A liver biopsy revealed abundant lymphoplasmacytic infiltrate with piecemeal necrosis and grade 2 fibrosis. He responded well to the corticosteroid treatment again, and was further treated with low-dose prednisone without additional relapses. Several years later, further management confirmed the presence of liver cirrhosis with no histological or biochemical signs of disease activity. DIAIH is a DILI phenotype that is difficult to distinguish from idiopathic AIH despite a wide armamentarium of diagnostic methods. It should always be considered among the differential diagnoses in patients presenting with hepatocellular liver injury.
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Affiliation(s)
- Dorotea Božić
- Department of Gastroenterology, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia;
| | - Ante Tonkić
- Department of Endocrinology, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; (A.T.J.); (M.R.)
| | - Katarina Vukojevic
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, 21000 Split, Croatia
| | - Maja Radman
- Department of Endocrinology, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; (A.T.J.); (M.R.)
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Ozdemir A, Kurtoglu S, Halis H, Bastug O. An evaluation of ursodeoxycholic acid treatment in prolonged unconjugated hyperbilirubinemia due to breast milk. Niger J Clin Pract 2023; 26:1226-1233. [PMID: 37794533 DOI: 10.4103/njcp.njcp_216_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Background/Aim Prolonged jaundice is one of the most common problems during neonatal period. The aim of this study was to evaluate the efficiency of ursodeoxycholic acid (UDCA) treatment in newborn infants with prolonged unconjugated hyperbilirubinemia. Materials and Methods The present study included 27 patients who were fed by breast milk and followed up in the outpatient clinic due to prolonged jaundice without any underlying etiological factor; 10 mg/kg/day UDCA was administrated in two doses for 7 days. Furthermore, 20 newborns diagnosed with prolonged jaundice with same characteristics were enrolled as the control group. The control group was also given a placebo; demographic characteristics, liver functions tests before and after the treatment, bilirubin decrease rates, and hemogram parameters of groups were compared. Results Total bilirubin levels in the study and control groups before the treatment were 16.02 ± 1.41 mg/dL and 15.93 ± 1.66 mg/dL, respectively (P = 0.84). Total bilirubin levels in the study and control groups at day 7 after UDCA treatment were detected 8.18 ± 2.31 mg/dL and 13.92 ± 2.66 mg/dL, respectively (P < 0.001), and at day 14 after the treatment were 5.45 ± 2.59 mg/dL and 11.91 ± 2.83 mg/dL, respectively (P < 0.001). Furthermore, serum aspartate aminotransferase (AST) was detected <21 U/L in the ROC analysis after UDCA treatment (P = 0.04). Conclusion The study outcomes indicated that an efficient reduction in total bilirubin levels may be achieved, and outpatient clinic follow-up period may be reduced in patients whom UDCA was administrated. Moreover, it may be speculated that AST can be used to evaluate the efficacy after treatment. However, studies with larger sample sizes are needed for the routine use of UDCA in the treatment of prolonged jaundice.
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Affiliation(s)
- A Ozdemir
- Department of Neonatalogy, University of Health Sciences, Kayseri City Hospital, Turkey
| | - S Kurtoglu
- Department of Pediatric Endocrinology, Memorial Kayseri Hospital, Kayseri, Turkey
| | - H Halis
- Department of Neonatalogy, Irmet Hospital, Tekirdag, Turkey
| | - O Bastug
- Department of Neonatalogy, University of Health Sciences, Kayseri City Hospital, Turkey
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Farhadi R, Keyhanian E, Naderisorki M, Nadi Ghara A. Effects of Two Different Doses of Ursodeoxycholic Acid on Indirect Hyperbilirubinemia in Neonates with Glucose-6-phosphate Dehydrogenase Deficiency Treated with Phototherapy: A Randomized Controlled Trial. Glob Pediatr Health 2023; 10:2333794X231156055. [PMID: 36814535 PMCID: PMC9940175 DOI: 10.1177/2333794x231156055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/22/2023] [Indexed: 02/19/2023] Open
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the causes of severe hyperbilirubinemia, prolonged jaundice, and bilirubin-induced encephalopathy in neonates. In a randomized controlled trial, we evaluated the effect of oral ursodeoxycholic acid (UDCA) on indirect hyperbilirubinemia in G6PD-deficient neonates requiring phototherapy. Intervention group I (N = 45; received phototherapy and 10 mg/kg/day UDCA), Intervention group II (N = 40; received phototherapy and 20 mg/kg/day UDCA), and a control group (N = 49; received phototherapy and placebo). Levels of total serum bilirubin (TSB) in all 3 groups decreased significantly over time (P = .001) but the level of TSB at different hours after admission and the duration of phototherapy did not differ significantly between the 3 groups. After discharge, the 2 intervention groups had a significantly lower rate of readmission than the control group (P = .001). No significant difference was observed between the 10 and 20 mg/kg/day groups. Further evaluation is recommended, especially in terms of the pharmacokinetics of UDCA in neonates. Trial registration number: IRCT20091201002801N4, prospectively registered on 2019-06-1.
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Affiliation(s)
- Roya Farhadi
- Pediatric Infectious Diseases Research Center, Mazandaran University of Medical Sciences, Sari, Iran,Roya Farhadi, Division of Neonatology, Department of Pediatrics, Boo Ali Sina Hospital, Mazandaran University of Medical Sciences, Pasdaran Boulevard, Sari 4816777145, Iran.
| | - Elham Keyhanian
- Pediatric Infectious Diseases Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Naderisorki
- Thalassemia Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Aliasghar Nadi Ghara
- Health Science Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
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Šimják P, Petr T, Kaslová B, Fejfar T, Hůlek P, Pařízek A, Vítek L. Ursodeoxycholic acid use in lactating female patients is associated with clinically negligible concentrations of this bile acid in breast milk. Sci Rep 2022; 12:19543. [PMID: 36379995 PMCID: PMC9666662 DOI: 10.1038/s41598-022-24253-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
In the literature on the safety of ursodeoxycholic acid (UDCA) during breastfeeding, insufficient data has been reported to date. Thus, the aim of our study was to analyze bile acid (BA) concentrations in breast milk in a cohort of patients, treated with UDCA, and with various cholestatic liver diseases. The study was carried out on a cohort of 20 patients with various cholestatic diseases. All the patients were treated with UDCA (500-1500 mg daily). Concentrations of BA, sampled on day 3 after delivery were analyzed using the GS-MS technique, and then compared to untreated women. Total BA concentrations in the breast milk of the UDCA-treated patients were equal to those of the untreated women controls (3.2 ± 1 vs. 3.2 ± 0.2 µmol/L, respectively). The UDCA concentrations in breast milk remained negligible in UDCA-treated patients (0.69 µmol/L), and in any event did not contribute to the newborn BA pool. No apparent side-effects of the maternal UDCA treatment were observed in any newborn infant, and no deterioration in postnatal development was observed during the routine 1-year follow-ups. Therapeutic administration of UDCA during lactation is safe for breastfed babies since UDCA only gets into breast milk in negligible amounts. UDCA treatment should be allowed and included into the guidelines for the therapy of cholestatic diseases in breastfeeding mothers.
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Affiliation(s)
- Patrik Šimják
- grid.411798.20000 0000 9100 9940Department of Gynecology and Obstetrics, General University Hospital in Prague and 1st Faculty of Medicine, Prague, Czech Republic
| | - Tomáš Petr
- grid.411798.20000 0000 9100 9940Institute of Medical Biochemistry and Laboratory Diagnostics, General University Hospital in Prague and 1st Faculty of Medicine, Prague, Czech Republic
| | - Barbora Kaslová
- grid.411798.20000 0000 9100 9940Department of Gynecology and Obstetrics, General University Hospital in Prague and 1st Faculty of Medicine, Prague, Czech Republic
| | - Tomáš Fejfar
- grid.412539.80000 0004 0609 2284Department of Internal Medicine, University Hospital in Hradec Králové and Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic
| | - Petr Hůlek
- grid.412539.80000 0004 0609 2284Department of Internal Medicine, University Hospital in Hradec Králové and Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic
| | - Antonín Pařízek
- grid.411798.20000 0000 9100 9940Department of Gynecology and Obstetrics, General University Hospital in Prague and 1st Faculty of Medicine, Prague, Czech Republic
| | - Libor Vítek
- grid.411798.20000 0000 9100 9940Institute of Medical Biochemistry and Laboratory Diagnostics, General University Hospital in Prague and 1st Faculty of Medicine, Prague, Czech Republic ,grid.4491.80000 0004 1937 116X4th Department of Internal Medicine, General University Hospital in Prague and 1st Faculty of Medicine, Charles University in Prague, U Nemocnice 2, Prague 2, 128 08 Czech Republic
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Kuitunen I, Kiviranta P, Sankilampi U, Renko M. Ursodeoxycholic acid as adjuvant treatment to phototherapy for neonatal hyperbilirubinemia: a systematic review and meta-analysis. World J Pediatr 2022; 18:589-597. [PMID: 35689782 PMCID: PMC9376150 DOI: 10.1007/s12519-022-00563-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/26/2022] [Indexed: 10/26/2022]
Abstract
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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Affiliation(s)
- Ilari Kuitunen
- Institute of Clinical Medicine, Department of Pediatrics, University of Eastern Finland, Kuopio, Finland. .,Department of Pediatrics, Mikkeli Central Hospital, Porrassalmenkatu 35-37, 50100, Mikkeli, Finland.
| | - Panu Kiviranta
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine, Department of Pediatrics, University of Eastern Finland, Kuopio, Finland ,grid.410705.70000 0004 0628 207XDepartment of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Ulla Sankilampi
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine, Department of Pediatrics, University of Eastern Finland, Kuopio, Finland ,grid.410705.70000 0004 0628 207XDepartment of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Marjo Renko
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine, Department of Pediatrics, University of Eastern Finland, Kuopio, Finland ,grid.410705.70000 0004 0628 207XDepartment of Pediatrics, Kuopio University Hospital, Kuopio, Finland
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Akefi R, Hashemi SM, Alinejad S, Almasi-Hashiani A. The effect of ursodeoxycholic acid on indirect hyperbilirubinemia in neonates treated with phototherapy: a randomized clinical trial. J Matern Fetal Neonatal Med 2020; 35:4075-4080. [PMID: 33225772 DOI: 10.1080/14767058.2020.1846705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Indirect hyperbilirubinemia during neonatal period is a common problem, and most preterm and more than half of the term neonates find this problem. Ursodeoxycholic acid (UDCA) protects the liver against oxidative stresses and prevents cellular apoptosis. In addition, it causes stimulation of bile flow, is well tolerated by the patient, and has limited side effects. Thus, the aim of this study was to investigate the effect of UDCA in treating neonates with unconjugated hyperbilirubinemia undergoing phototherapy. METHODS In this randomized clinical trial, 220 neonates with unconjugated hyperbilirubinemia who referred to Amir-Kabir Hospital, Arak, Iran in 2017-2018, were randomly assigned to phototherapy group (Control group) and phototherapy plus UDCA group (Intervention group) as 10 mg/kg/day. The level of total bilirubin was measured at the baseline, and after 12, and 24 h using spectrophotometric, and the duration of receiving phototherapy was also measured in both groups. RESULTS The mean age of included neonates in the control and intervention group was 5.3 and 4.9 days, respectively. The results revealed that after 12 h of treatment, the total bilirubin level in the control group had diminished by 2.70 mg/dL on average while, in the intervention group, the reduction was 3.7 md/dL (p = .001) and after 24 h of treatment, the total bilirubin level in the control group had diminished by 5.22 mg/dL on average and in the intervention group, the reduction was 6.54 md/dL (p = .001). It was also observed that there is no significant difference between groups in terms of the mean of the duration required for phototherapy (p = .63). CONCLUSIONS UDCA combined with phototherapy enhances TSB decrease, but this effect is not relevant from a clinical point of view because it does not decrease phototherapy and hospital stay duration. Thus, this study does not support the UDCA use in the clinical practice. TRIAL REGISTRATION IRCT, IRCT2017071515511N2. Registered 21 Aug 2017 - Retrospectively registered, https://en.irct.ir/trial/14763.
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Affiliation(s)
- Rona Akefi
- Student Research Committee, Arak University of Medical Sciences, Arak, Iran
| | - Seyed Mojtaba Hashemi
- Department of Pediatrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Saeed Alinejad
- Department of Pediatrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
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