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Phototherapy-associated diarrhea. The role of bile salts
Insights
Phototherapy for jaundiced newborns significantly increases fecal bile salts, potentially causing diarrhea. Bile salt levels return to normal after phototherapy (PT) ends.
Area of Science:
- Neonatal Medicine
- Gastroenterology
- Pediatric Phototherapy
Background:
- Jaundice is common in newborns.
- Phototherapy is a standard treatment for neonatal jaundice.
- Diarrhea is a potential side effect of phototherapy.
Purpose of the Study:
- To investigate the effect of phototherapy on fecal bile salt concentrations in jaundiced neonates.
- To explore the relationship between elevated bile salts and phototherapy-associated diarrhea.
Main Methods:
- Fecal bile salt concentrations were measured in 14 jaundiced neonates undergoing phototherapy (PT group) and 14 matched controls.
- Measurements were taken before, during (12 hours), and after (24 hours) phototherapy.
- Stool characteristics (e.g., watery stools, sodium content) were also assessed.
Main Results:
- Before phototherapy, bile salt levels were similar between groups.
- At 12 hours of phototherapy, PT group showed significantly higher mean bile salt concentrations (3.65 +/- 0.39 mmol/l) compared to controls (2.62 +/- 0.22 mmol/l).
- Elevated bile salt concentrations (>= 3.5 mmol/l) were observed in nine PT infants, with six experiencing watery stools.
Conclusions:
- Phototherapy significantly increases fecal bile salt concentration in jaundiced neonates.
- High fecal bile salt levels during phototherapy appear to contribute to the pathogenesis of diarrhea in this population.
- Monitoring bile salt levels may be relevant in managing phototherapy-associated complications.
Abstract:
The concentration of fecal bile salts was measured in 14 jaundiced neonates who received phototherapy (PT group) and their 14 nontreated matched controls (C). Before initiation of phototherapy, mean bile salt concentrations in stool specimens from the two groups were similar. At 12 hours of 'lights on', stool specimens from PT babies showed a significantly increased mean bile salt concentration, whereas in the C babies there was no change (3.65 +/- 0.39 vs 2.62 +/- 0.22 mmol/l; p less than 0.01). At 24 hours after 'lights off', stool specimens from the PT infants had a mean bile salt concentration like that before phototherapy, and not different from C. During phototherapy, nine PT babies had a bile salt concentration in their stools of 3.5 mmol/l and above; 6 of these babies had watery stools with a high sodium content. The high concentration of bile salts found in the colonic contents of neonates during phototherapy would appear to be a factor in the pathogenesis of phototherapy-associated diarrhea in the jaundiced neonate.