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Serum cholic acid and chenodeoxycholic acid concentrations in neonatal hyperbilirubinemia
Insights
Serum primary bile acid levels are higher in newborns with hyperbilirubinemia, but their measurement offers limited diagnostic value for assessing neonatal cholestasis severity or prognosis.
Area of Science:
- Neonatology
- Hepatology
- Biochemistry
Background:
- Neonatal hyperbilirubinemia is common, often resolving spontaneously.
- Cholestasis can be a complication, necessitating accurate diagnosis.
- Primary bile acids are potential biomarkers for liver function.
Purpose of the Study:
- To investigate serum primary bile acid concentrations in newborns with and without hyperbilirubinemia.
- To assess the correlation between primary bile acids and cholestasis in neonates.
- To evaluate the diagnostic utility of primary bile acids for neonatal hyperbilirubinemia.
Main Methods:
- Serum samples were collected from 332 hyperbilirubinemic and 95 nonhyperbilirubinemic neonates.
- Concentrations of cholic acid and chenodeoxycholic acid were measured.
- Hyperbilirubinemic infants were assessed for cholestasis based on bile acid levels.
Main Results:
- Significantly higher serum cholic and chenodeoxycholic acid levels were observed in hyperbilirubinemic newborns.
- 24% of hyperbilirubinemic neonates met criteria for true cholestasis.
- The ratio of cholic to chenodeoxycholic acid was higher in cholestatic infants.
- Alkaline phosphatase and lactate dehydrogenase levels did not differ significantly between cholestatic and noncholestatic groups.
- Primary bile acids were generally elevated in hyperbilirubinemic infants without specific patterns.
Conclusions:
- Elevated serum primary bile acids are associated with neonatal hyperbilirubinemia.
- Measurement of serum primary bile acids has limited value in diagnosing neonatal cholestasis or predicting outcomes.
- Further research may explore other biomarkers for neonatal cholestasis.
Abstract:
Primary bile acid concentrations were measured in serum of 332 newborns with neonatal hyperbilirubinemia (serum total bilirubin level greater than 200 mumol/l) and compared with those of 95 nonhyperbilirubinemic neonates (serum total bilirubin level less than 200 mumol/l). The serum concentrations (mumol/l; mean +/- SEM) for cholic acid (8.78 +/- 0.44) and chenodeoxycholic acid (10.5 +/- 0.68) were significantly higher (p less than 0.001) in the hyperbilirubinemic group than in the controls (7.16 +/- 0.48 and 6.67 +/- 0.48, respectively). 80 (24%) of the hyperbilirubinemic newborns had true cholestasis (serum levels of cholic and/or chenodeoxycholic acid higher than mean +/- 2 SD in the reference group). The ratio of cholic to chenodeoxycholic acid was significantly higher (p less than 0.05) in the cholestatic group than in the hyperbilirubinemic newborns without cholestasis. There was no significant differences in the serum concentrations of alkaline phosphatase or lactate dehydrogenase between the cholestatic and noncholestatic groups. In the hyperbilirubinemic newborns, the primary bile acids were indiscriminately raised. Only 8 infants from the 332 newborns had jaundice at the age of 1 month. Of these 8 infants only 2 had neonatal cholestatic hyperbilirubinemia. It thus appears that measurement of serum primary bile acid concentrations has only limited diagnostic value in assessing the severity or prognosis of neonatal hyperbilirubinemia.