Ursodeoxycholic Acid Treatment in Preterm Infants: A Pilot Study for the Prevention of Cholestasis Associated With Total Parenteral Nutrition

Abstract

In a prospective, double-blind, placebo-controlled trial, the efficacy and safety of ursodeoxycholic acid (UDCA) was evaluated in preterm infants, in terms of its potential impact on fat absorption, advancement of enteral feeding, development of cholestasis, growth, nutritional status, and metabolic status. Although fecal fat excretion slightly decreased and achievement of full enteral feeding was earlier in the UDCA group, these differences were not significant. Interestingly, whereas serum gamma-glutamyl transferase activity increased during the parenteral nutrition period in the placebo group, we observed a constant and significant decrease in the UDCA group. This observation warrants further investigation to determine the utility of prophylactic UDCA in preventing cholestasis in infants with prolonged parenteral nutrition.

A contemporary analysis of parenteral nutrition–associated liver disease in surgical infants

“…Techniques for continuous and postpyloric feedings as well as elemental and hypoallergenic formulas have helped to promote the use of enteral nutrition [9,18]. Finally, ursodiol has been studied for its effects on reducing hyperbilirubinemia associated with PN, although recent prospective data question its efficacy in preventing hyperbilirubinemia [10,21].…”

A controlled trial of erythromycin and UDCA in premature infants during parenteral nutrition in minimizing feeding intolerance and liver function abnormalities

“…Time to achieve FEF was also not significantly different from that in the placebo group. 21 In our study, we could not evaluate fat absorption, and no significant difference in time to achieve FEF was found between the placebo and UDCA groups. Our results indicate that VLBW infants with feeding intolerance caused by non-anatomically obstructive gastrointestinal dysmotility achieved FEF significantly earlier after treatments.…”

“…During feeding, the fat content of the duodenum is one of the major determinants of the gastric emptying. In the study of Arslanoglu et al, 21 fat absorption was improved with UDCA treatment, but the difference was not significant. Time to achieve FEF was also not significantly different from that in the placebo group.…”

“…20 Recently, it has been shown that UDCA treatment can prevent IFALD in VLBW infants. 21 In that study, treatment began on day 3 of life, and a significant decline in GGT activity was seen in the UDCA-treated patients. Also, aspartate aminotransferase and alanine aminotransferase activities declined.…”

Inspissated Bile Syndrome in a Neonate Treated With Cefotaxime

“…Ursodeoxycholic acid is a hydrophilic bile acid that enriches the bile acid pool, decreases the biliary saturation of cholesterol, and may prevent sludge formation. 8,9 It was found to resolve symptoms in pediatric patients with gallstones; however, the stones transiently disappeared in only 2 of 15 patients in one study 10 and in 8 of 180 in another.…”