Parenteral Nutrition Associated Cholestasis Is Earlier, More Prolonged and Severe in Small for Gestational Age Compared with Appropriate for Gestational Age Very Low Birth Weight Infants.
10.3349/ymj.2013.54.4.839
- Author:
Soon Min LEE
1
;
Ran NAMGUNG
;
Min Soo PARK
;
Ho Sun EUN
;
Nam Hyo KIM
;
Kook In PARK
;
Chul LEE
Author Information
1. Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea. Ranng@yuhs.ac
- Publication Type:Original Article ; Observational Study ; Research Support, Non-U.S. Gov't
- Keywords:
Parenteral nutrition associated cholestasis;
small for gestational age;
appropriate for gestational age;
hepatic dysfunction
- MeSH:
Bilirubin/blood;
Case-Control Studies;
Cholestasis/diagnosis/epidemiology/*etiology;
Comorbidity;
Female;
Humans;
Infant, Newborn;
Infant, Premature, Diseases/epidemiology/etiology;
*Infant, Small for Gestational Age;
Infant, Very Low Birth Weight;
Liver/metabolism/physiopathology;
Male;
Parenteral Nutrition/*adverse effects
- From:Yonsei Medical Journal
2013;54(4):839-844
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: We hypothesized that parenteral nutrition associated cholestasis (PNAC) would be more severe in small for gestational age (SGA) compared with appropriate for gestational age (AGA) very low birth weight (VLBW) infants. MATERIALS AND METHODS: Sixty-one VLBW infants were diagnosed as PNAC with exposure to parenteral nutrition with elevation of direct bilirubin > or =2 mg/dL for > or =14 days. Twenty-one SGA infants and 40 AGA infants matched for gestation were compared. RESULTS: Compared with AGA infants, PNAC in SGA infants was diagnosed earlier (25+/-7 days vs. 35+/-14 days, p=0.002) and persisted longer (62+/-36 days vs. 46+/-27 days, p=0.048). Severe PNAC, defined as persistent elevation of direct bilirubin > or =4 mg/dL for more than 1 month with elevation of liver enzymes, was more frequent in SGA than in AGA infants (61% vs. 35%, p=0.018). The serum total bilirubin and direct bilirubin levels during the 13 weeks of life were significantly different in SGA compared with AGA infants. SGA infants had more frequent (76% vs. 50%, p=0.046), and persistent elevation of alanine aminotransferase. CONCLUSION: The clinical course of PNAC is more persistent and severe in SGA infants. Careful monitoring and treatment are required for SGA infants.
