Effect of Ursodeoxycholic Acid in Unconjugated Hyperbilirubinemia in the Term Neonates Treated with Phototherapy: A Systematic Review

JOURNAL TITLE: Newborn

Author
ISSN
DOI
10.5005/jp-journals-11002-0046
Volume
1
Issue
4
Publishing Year
2022
Pages
12
Article keywords
Hyperbilirubinemia, Neonates, Phototherapy, Physiological jaundice, Systematic review, Ursodeoxycholic acid

Abstract

Background: Neonatal hyperbilirubinemia is a common clinical condition worldwide. Phototherapy (PT) is the standard intervention for hyperbilirubinemia; however, it may have side effects. It has been suggested that the implementation of adjuvant therapy including ursodeoxycholic acid (UDCA), for example, may decrease the duration of PT. Objectives: To determine the efficacy and safety of UDCA in addition to PT in term neonates with unconjugated hyperbilirubinemia (UH) vs PT alone. Methods: A systemic review was undertaken using the following databases: PubMed, Medline, Cochrane database, Scopus, Google Scholar, and ClinicalTrials.gov. Randomized controlled trials (RCTs) assessing the efficacy and safety of UDCA combined with PT on the total serum bilirubin (TSB) and duration of PT were included. The data quality assessment was carried out. Results: Low–moderate quality evidence from seven RCTs reported significantly lower TSB levels in the UDCA group compared to the control group after 12, 24, 48, and 72 hours of treatment with a mean difference (MD) of –2.23 mg/dL (95% CI: from −2.49 to −1.96); −1.59 mg/dL (95% CI: from −1.83 to −1.35); −1.03 mg/dL (95% CI: from −1.27 to −0.79); and −1.32 mg/dL (95% CI: from −1.63 to −1.01), respectively, with heterogeneity of studies I2 = 92% (p < 0.00001). In addition, three studies observed that UDCA significantly decreased the duration of PT with MD −19.14 hours (95% CI: from −20.70 to −17.59) with heterogeneity I2 = 91% (p < 0.00001). None of the studies reported any significant adverse effects of UDCA. Conclusion: Ursodeoxycholic acid combined with PT in the treatment of UH significantly reduces the TSB and duration of PT without significant risk of adverse events. However, limited and low–moderate quality evidence exists to support the routine use of UDCA in neonates. We discuss the limitations of the review results for clinical practice.

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