Ursodeoxycholic acid for preventing parenteral nutrition-associated cholestasis in neonates: A systematic review and meta-analysis

IF 2.1 4区 医学 Q3 PHARMACOLOGY & PHARMACY Fundamental & Clinical Pharmacology Pub Date : 2024-02-11 DOI:10.1111/fcp.12993
Rajendra Prasad Anne, Srikanth Puttaiah Kadyada, Abhishek Somasekhara Aradhya, Tejo Pratap Oleti
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Abstract

Background

While ursodeoxycholic acid is used in treating parenteral nutrition-associated cholestasis (PNAC) in neonates, its role in prevention is unclear.

Objectives

In this systematic review and meta-analysis, we attempted to determine the role of ursodeoxycholic acid in preventing PNAC in neonates.

Methods

PubMed, Embase, Cochrane Library, Scopus, and CINAHL databases were searched on September 16, 2023, for interventional studies comparing ursodeoxycholic acid with placebo.

Results

Of the 6180 unique records identified, five studies were eligible for inclusion (three randomised and two nonrandomised). Evidence from randomised trials showed that ursodeoxycholic acid prophylaxis did not reduce cholestasis, mortality, sepsis, and necrotising enterocolitis. Ursodeoxycholic acid prophylaxis reduced feed intolerance (RR 0.23 (0.09, 0.64); 1 RCT, 102 neonates), peak conjugated bilirubin levels (MD −0.13 (−0.22, −0.04) mg/dL; 1 RCT, 102 neonates), and time to full enteral feeds (MD −2.7 (−5.09, −0.31) days; 2 RCTs, 76 neonates). There was no decrease in hospital stay and parenteral nutrition duration. Data from nonrandomised studies did not show benefit in any of the outcomes. The certainty of the evidence was low to very low.

Conclusion

Because of the very low-quality evidence and lack of evidence on critical outcomes, definitive conclusions could not be made on using ursodeoxycholic acid to prevent parenteral nutrition-associated cholestasis in neonates.

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熊去氧胆酸用于预防新生儿肠外营养相关性胆汁淤积症:系统综述和荟萃分析。
背景:熊去氧胆酸可用于治疗新生儿肠外营养相关性胆汁淤积症(PNAC),但其预防作用尚不明确:在本系统综述和荟萃分析中,我们试图确定熊去氧胆酸在预防新生儿 PNAC 中的作用:2023 年 9 月 16 日,我们在 PubMed、Embase、Cochrane Library、Scopus 和 CINAHL 数据库中检索了熊去氧胆酸与安慰剂比较的干预性研究:结果:在已确定的 6180 条唯一记录中,有五项研究符合纳入条件(三项随机试验和两项非随机试验)。随机试验的证据显示,熊去氧胆酸预防性治疗并不能减少胆汁淤积、死亡率、败血症和坏死性小肠结肠炎。熊去氧胆酸预防可减少喂养不耐受(RR 0.23 (0.09, 0.64);1 项随机试验,102 例新生儿)、结合胆红素峰值(MD -0.13 (-0.22, -0.04) mg/dL;1 项随机试验,102 例新生儿)和完全肠内喂养时间(MD -2.7 (-5.09, -0.31) 天;2 项随机试验,76 例新生儿)。住院时间和肠外营养时间没有缩短。来自非随机研究的数据未显示任何结果的益处。证据的确定性为低至极低:由于证据质量极低,且缺乏关键结果方面的证据,因此无法就使用熊去氧胆酸预防新生儿肠外营养相关性胆汁淤积症得出明确结论。
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来源期刊
CiteScore
5.30
自引率
6.90%
发文量
111
审稿时长
6-12 weeks
期刊介绍: Fundamental & Clinical Pharmacology publishes reports describing important and novel developments in fundamental as well as clinical research relevant to drug therapy. Original articles, short communications and reviews are published on all aspects of experimental and clinical pharmacology including: Antimicrobial, Antiviral Agents Autonomic Pharmacology Cardiovascular Pharmacology Cellular Pharmacology Clinical Trials Endocrinopharmacology Gene Therapy Inflammation, Immunopharmacology Lipids, Atherosclerosis Liver and G-I Tract Pharmacology Metabolism, Pharmacokinetics Neuropharmacology Neuropsychopharmacology Oncopharmacology Pediatric Pharmacology Development Pharmacoeconomics Pharmacoepidemiology Pharmacogenetics, Pharmacogenomics Pharmacovigilance Pulmonary Pharmacology Receptors, Signal Transduction Renal Pharmacology Thrombosis and Hemostasis Toxicopharmacology Clinical research, including clinical studies and clinical trials, may cover disciplines such as pharmacokinetics, pharmacodynamics, pharmacovigilance, pharmacoepidemiology, pharmacogenomics and pharmacoeconomics. Basic research articles from fields such as physiology and molecular biology which contribute to an understanding of drug therapy are also welcomed.
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