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


CONCLUSIONS
Addition of BM increases the diagnostic accuracy  of the HBS and this would lead to decreased need for POC to distinguish NH  from EHBA.
Gupta
D K
DK
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India. devendra6@hotmail.com
Charles
A R
AR
Srinivas
M
M
Dave
S
S
Bal
C S
CS
D001623:Betamethasone; D001651:Cholestasis, Extrahepatic / Q000175:diagnosis / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000175:diagnosis / Q000000981:diagnostic imaging*; D008297:Male; D010634:Phenobarbital; D011856:Radiographic Image Enhancement / Q000379:methods*; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D001623:Betamethasone; D010634:Phenobarbital