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Background. The purpose of this study was to evaluate the efficacy of ursodeoxycholic acid (UDCA) in the treatment of cholestasis and hyperbilirubinemia in a pediatric intensive care unit population. Methods. Medical records were retrospectively reviewed to identify children and adolescents in the pediatric intensive care unit (PICU) who received UDCA for the treatment of hyperbilirubinemia and cholestasis. Results. Ursodeoxycholic acid was administered at a dose of 20 mg/kg per day to 5 PICU patients with cholestasis and hyperbilirubinemia of various etiologies. In 4 of 5 patients, there was a decrease in serum bilirubin levels following the start of UDCA therapy. There was no response to therapy in 1 patient, who developed disseminated fungal disease and died. No adverse effects related to therapy were noted. Conclusions. These preliminary data suggest that UDCA is effective in the treatment of cholestasis and hyperbilirubinemia of various etiologies in the PICU patient. Prospective, randomized trials are warranted to further assess the efficacy of this therapy in this patient population. [ABSTRACT FROM AUTHOR]