Skip to main content

Betamethasone in plus phenobarbitone prior to hepatobiliary scintigraphy increases diagnostic accuracy in infants with jaundice

The Indian Journal of Pediatrics volume 68, pages 1039–1041 (2001)Cite this article

Abstract

Objective. In the diagnostic work up of the child with neonatal obstructive cholangiopathy (NOC), hepatobiliary scintigraphy (HBS) determines the need for peroperative cholangiography (POC). Traditionally, phenobarbitone is recommended to prime the liver to HBS. This retrospective study was designed to evaluate whether addition of the betamethasone (BM) alters the diagnostic accuracy of the HBS in distinguishing neonatal hepatitis (NH) from extra hepatic biliary atresia (EHBA).Methods : Between 1993 – 1999, 202 patients presented with NOC and this study was not designed as a prospective randomized clinical trial. Of these, 126 patients had received Phenobarbitone (Group I) and the remaining 76 (Group II) had received BM in addition to the PB in a dose of 5 mg/k/d and 2.2 mg/k/d respectively for 7 days prior to HBS.Results : Retrospective analysis revealed that, in the Group I, 41 showed excretion and 85 did not show any excretion of the radiopharmaceutical and the latter underwent POC which revealed that 31 patients (36%) of them showed patent biliary tract. In group II, 32 patients revealed excretion and 44 did not show any excretion of the radiopharmaceutical and the latter had undergone POC, which revealed that only 8 patients (18%) showed patent biliary tract. The percentages of false positives (36% vs 18%) was statistically significant (p<0.03).Conclusion : Addition of BM increases the diagnostic accuracy of the HBS and this would lead to decreased need for POC to distinguish NH from EHBA.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Kirks DR, Coleman RE, Filston HC, Rosenberg ER, Merten DF. An imaging approach to persistent neonatal jaundice.AJR Am J Roentgenol 1984; 142: 461–465.

    PubMed  CAS  Google Scholar 

  2. Kasai M. Results of surgery for biliary atresia. In Javitt NB, ed.Neonatal Hepatitis and Biliary Atresia. United States Department of Health education and Welfare Publication, Anol (NIH) 79, 1296, Bethesda, Maryland: 1979 : 417–430.

    Google Scholar 

  3. Hitch DC, Leonard JC, Pysher TJ, Manion CV, Smith EI. Differentiation of cholestatic jaundice in infants. Utility of diethyl-IDA.Am J Surg 1981; 142: 671–677.

    PubMed  Article  CAS  Google Scholar 

  4. Majd M, Reba RC, Altman RP. Hepatobiliary scintigraphy with 99mTc-PIPIDA in the evaluation of neonatal jaundice.Pediatrics 1981; 67: 140–145.

    PubMed  CAS  Google Scholar 

  5. Majd M, Reba RC, Altman RP. Effect of phenobarbital on 99mTc-IDA scintigraphy in the evaluation of neonatal jaundice.Setnin Nucl Med 1981; 11: 194–204.

    CAS  Google Scholar 

  6. Macarol V, Morris TQ, Baker KJ, Bradley SE. Hydrocortisone choleresis in the dog.J Clin Invest 1970; 49: 1714–1723.

    PubMed  CAS  Article  Google Scholar 

  7. Miner PB Jr, Gaito JM. Bile flow in response to pharmacologic agents. Hepatic DNA as a reference standard.Biochem Pharmacol 1979; 1; 28(7): 1063–1066.

    PubMed  Article  CAS  Google Scholar 

  8. Muraji T, Higashimoto Y. The improved outlook for biliary atresia with corticosteroid therapy.J Pediatr Surg 1997; 32: 1103–1106.

    PubMed  Article  CAS  Google Scholar 

  9. Karrer FM, Lilly JR. Corticosteroid therapy in biliary atresia.J Pediatr Surg 1985; 20: 693–695.

    PubMed  Article  CAS  Google Scholar 

  10. Manolaki AG, Larcher VF, Mowat AP, Barrett JJ, Portmann B, Howard ER. The prelaparotomy diagnosis of extrahepatic biliary atresia.Arch Dis Child 1983; 58: 591–594.

    PubMed  CAS  Article  Google Scholar 

  11. Thaler MM, Gellis SS. Studies in neonatal hepatitis and biliary atresia. I. Long-term prognosis of neonatal hepatitis.Am J Dis Child 1968; 116: 257–261.

    PubMed  CAS  Google Scholar 

  12. Miner PB Jr, Sutherland E, Simon FR. Regulation of hepatic sodium plus potassium-activated adenosine triphosphatase activity by glucocorticoids in the rat.Gastroenterology 1980; 79: 212–221.

    PubMed  CAS  Google Scholar 

  13. Schimmer BP, Parker KL. Adrenocorticotrophic hormone; adreno-cortical steroids and their synthetic analogues; inhibitors of the synthesis and actions of adrenocortical hormones. In Hardman JG, Limbird LE, Molinoff PBet al, eds.Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 9th edn, McGraw-Hill, 1459-1485.

  14. Katz R, Ducci H, Alessandri H. Influence of cortisone and prednisolone on hyperbilirubinemia.J Clin Invest 36 :1370-1374.

  15. Altman RP, Anderson KD. Surgical management of intractable cholangitis following successful Kasai procedure.J Pediatr Surg 1982; 17: 894–900.

    PubMed  Article  CAS  Google Scholar 

  16. Ohi R, Hanamatsu M, Mochizuki I, Chiba T, Kasai M. Progress in the treatment of biliary atresia.World J Surg 1985; 9: 285–293.

    PubMed  Article  CAS  Google Scholar 

  17. Kasai M, Suzuki H, Ohashi E, Ohi R, Chiba T, Okamoto A. Technique and results of operative management of biliary atresia.World J Surg 1978; 2: 571–579.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India

    D. K. Gupta, A. R. Charles, M. Srinivas, S. Dave & C. S. Bal

  2. Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India

    C. S. Bal

Authors
  1. D. K. Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. R. Charles
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Srinivas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Dave
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. S. Bal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. K. Gupta.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Gupta, D.K., Charles, A.R., Srinivas, M. et al. Betamethasone in plus phenobarbitone prior to hepatobiliary scintigraphy increases diagnostic accuracy in infants with jaundice. Indian J Pediatr 68, 1039–1041 (2001). https://doi.org/10.1007/BF02722353

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02722353

Key words

  • Hepatobiliary scintigraphy
  • Neonatal hepatitis
  • Extrahepatic biliary atresia