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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
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Year : 1999  |  Volume : 4  |  Issue : 2  |  Page : 97-100

Use of phenobarbital and betamethasone before 99m Tc-HIDA scintigraphy in the evaluation of neonatal jaundice.


Department of Pediatric Surgery and Nuclear Medicine, All Institute of Medical Sciences, New Delhi-110029, India

Correspondence Address:
DK Gupta
Department of Pediatric Surgery and Nuclear Medicine, All Institute of Medical Sciences, New Delhi-110029
India
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Source of Support: None, Conflict of Interest: None


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ABSTRACT: Nuclear imaging techniques using Tc-99m iminodiacetic acid derivatives have been employed extensively to differentiate billiary atresia (BA) from other causes of neonatal jaundice (NH). The use of phenobarbital prior to the nuclear scan to increase the accuracy of the study is widely accepted. During 1995-97, 59 patients underwent HIDA scan for obstructive cholangiopathy following phenobarbital therapy for 5-7 days. Only 15 patients (25 percent) showed excretion in the gut and were diagnosed as neonatal hepatitis. On 44 remaining patients with suspected biliary atresia on HIDA scanning, operative cholangiogram was performed on 7 patients; 2 of them showed patent biliary tree. In the remaining 37 patients, the HIDA study was repeated after adding betamethasone to phenobarbital for 5-7 days; 14 (38 percent) of these showed excretion now and were diagnosed again as NH. Surgical exploration was performed on the remaining 23 patients; 2 of them again showed patent biliary tree and were labelled as NH. Thus with the use of PB, a total of 18/33 (54.5 percent) patients with NH were misdiagnosed as BA. However, with the addition of BM to PB, 14/16 patients with NH were correctly diagnosed on HIDA scanning. The remaining 2 patients (2/16-12.5 percent) required operative cholangiogram to rule out BA Both these had severe cholestasis. We advocate the use of betamethasone in addition to phenobarbital in all patients undergoing HIDA scanning for suspected neonatal jaundice to achieve the maximal hepatoenteric clearance rate without delay.






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