Document Detail


High-dose steroids, ursodeoxycholic acid, and chronic intravenous antibiotics improve bile flow after Kasai procedure in infants with biliary atresia.
MedLine Citation:
PMID:  12632357     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND/PURPOSE: Early reports suggest that the use of steroids after Kasai portoenterostomy may improve bile flow and outcome in infants with biliary atresia. METHODS: Of 28 infants with biliary atresia, half received adjuvant high-dose steroids, and half received standard therapy. Infants in the steroid group (n = 14) received intravenous solumedrol (taper of 10, 8, 6, 5, 4, 3, 2 mg/kg/d), followed by 8 to 12 weeks of prednisone (2 mg/kg/d). The steroid protocol also included ursodeoxycholic acid indefinitely and intravenous antibiotics for 8 to 12 weeks followed by oral antibiotic prophylaxis. Infants in the standard therapy group (n = 14) received no steroids, occasional ursodeoxycholic acid, and perioperative intravenous antibiotics followed by oral antibiotic prophylaxis. The infants were not assigned randomly, but rather received standard therapy or adjuvant steroid therapy according to individual surgeon preference. RESULTS: Eleven of 14 (79%) in the steroid group and 3 of 14 (21%) in the standard therapy group had a conjugated bilirubin level less than 1.0 within 3 to 4 months of surgery (P <.001). Fewer patients in the steroid group (21% v 85%) required liver transplantation or died during the first year of life (P <.001). Infants in the steroid group did better despite the fact that this group included 5 infants with biliary atresia-polysplenia-heterotaxia syndrome, a subgroup that might have been expected to have a poor prognosis. Neither bile duct size nor liver histology was a reliable predictor of success or failure in either group. CONCLUSIONS: Adjuvant therapy using high-dose steroids, ursodeoxycholic acid, and intravenous antibiotics may accelerate the clearance of jaundice and decrease the need for early liver transplantation after Kasai portoenterostomy.
Authors:
Rebecka L Meyers; Linda S Book; Molly A O'Gorman; W Daniel Jackson; Richard E Black; Dale G Johnson; Michael E Matlak
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Review    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  38     ISSN:  1531-5037     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  2003 Mar 
Date Detail:
Created Date:  2003-03-12     Completed Date:  2003-11-05     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  406-11     Citation Subset:  IM    
Copyright Information:
Copyright 2003, Elsevier Science (USA). All rights reserved.
Affiliation:
Divisions of Pediatric Surgery and Pediatric Gastroenterology, Primary Children's Medical Center, University of Utah School of Medicine, Salt Lake City, Utah 84113, USA.
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Adrenal Cortex Hormones / administration & dosage,  therapeutic use*
Anti-Bacterial Agents / administration & dosage,  therapeutic use*
Antibiotic Prophylaxis
Bile / secretion*
Biliary Atresia / drug therapy,  physiopathology,  surgery*
Chemotherapy, Adjuvant
Cholagogues and Choleretics / therapeutic use*
Cholestasis / prevention & control*
Female
Humans
Infant
Infusions, Intravenous
Liver Transplantation / utilization
Male
Methylprednisolone Hemisuccinate / administration & dosage,  therapeutic use
Portoenterostomy, Hepatic*
Postoperative Complications / prevention & control*
Prednisone / administration & dosage,  therapeutic use
Retrospective Studies
Treatment Outcome
Ursodeoxycholic Acid / therapeutic use*
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Anti-Bacterial Agents; 0/Cholagogues and Choleretics; 128-13-2/Ursodeoxycholic Acid; 2921-57-5/Methylprednisolone Hemisuccinate; 53-03-2/Prednisone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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