Ursodeoxycholic acid as adjuvant treatment to phototherapy for neonatal hyperbilirubinemia:a systematic review and meta‑analysis

Background Neonatal hyperbilirubinemia is observed in most newborns,and 5–15%of neonates require phototherapy.Phototherapy is efective but often prolongs hospitalization and has both short-term and potential long-term harms.The aim of this systematic review and meta-analysis was to evaluate the role of ursodeoxycholic acid(UDCA)combined with phototherapy in neonatal hyperbilirubinemia.Methods A literature search was conducted on September 1,2021;590 studies were screened,and 17 full texts were assessed by two authors.We included randomized controlled trials with or without placebo intervention.Primary outcomes were changes in total bilirubin levels at 24 hours and phototherapy duration.We calculated mean diferences with 95%confdence intervals(CI).Results Six studies with 880 neonates were included.Of these studies,only two used a placebo-controlled double-blinded design.The overall risk of bias was high in one and moderate in four of the included studies.The mean decrease in the total bilirubin level during the frst 24 hours was 2.06 mg/dL(95%CI 0.82–3.30;six studies)greater in the UDCA treatment group.The phototherapy duration was 19.7 hours(95%CI 10.4–29.1;fve studies)shorter in the UDCA treatment group.Conclusions We found low-quality evidence that UDCA as an adjuvant to phototherapy seems to decrease total bilirubin faster and shorten phototherapy duration compared to standard treatment.Further studies are needed to confrm the efcacy,acute and long-term outcomes,and safety before implementing UDCA as an adjuvant to phototherapy in neonatal hyperbilirubinemia.

Incidence of pediatric injury visits decreased while trauma surgeries remained stable during the first and second waves of the COVID-19 pandemic in Finland:a register-based study

Introduction The COVID-19 pandemic has reduced pediatric emergency department(ED)visits and surgeries.This study evaluates the incidence of pediatric trauma ED visits and surgeries in Finland during the first and second waves of the pandemic.Methods Three large Finnish hospitals,covering one-sixth of the Finnish pediatric population,participated.Data on all ED visits and trauma surgeries between January 2017 and December 2020 were collected from hospital discharge registers.Monthly incidences with 95%CI were calculated per 100000 person-months by Poisson exact method and compared by incidence rate ratio(IRR).Results During the lockdown the incidence of head injuries(IRR 0.19,95%CI 0.04 to 0.87),sprains(IRR 0.25,95%CI 0.14 to 0.46),and fractures(IRR 0.36,95%CI 0.25 to 0.51)decreased in the 13-17 years age group.In the 4-12 years age group a 55%decrease(IRR 0.45,95%CI 0.22 to 0.96)in head injuries was observed.During the period of regional restrictions a subtle decrease in head injuries was seen in the 13-17 years age group(IRR 0.26,95%CI 0.09 to 0.78).During the lockdown in March 2020 the incidence of fractures decreased in the oldest age group(13-17 years)(IRR 0.62,95%CI 0.46 to 0.85),while a rebound in incidence was seen at the end of the lockdown period in June.Conclusion The nationwide lockdown and the cancellation of sports and other hobbies markedly decreased the injuries among children aged 13-17 years,while the decrease was lower among children aged 4-12 years.Cancellation of sports and hobbies did not affect patients under 4 years of age.