Document Detail


Efficacy of fat-soluble vitamin supplementation in infants with biliary atresia.
MedLine Citation:
PMID:  22891232     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Cholestasis predisposes to fat-soluble vitamin (FSV) deficiencies. A liquid multiple FSV preparation made with tocopheryl polyethylene glycol-1000 succinate (TPGS) is frequently used in infants with biliary atresia (BA) because of ease of administration and presumed efficacy. In this prospective multicenter study, we assessed the prevalence of FSV deficiency in infants with BA who received this FSV/TPGS preparation.
METHODS: Infants received FSV/TPGS coadministered with additional vitamin K as routine clinical care in a randomized double-blinded, placebo-controlled trial of corticosteroid therapy after hepatoportoenterostomy (HPE) for BA (identifier NCT 00294684). Levels of FSV, retinol binding protein, total serum lipids, and total bilirubin (TB) were measured 1, 3, and 6 months after HPE.
RESULTS: Ninety-two infants with BA were enrolled in this study. Biochemical evidence of FSV insufficiency was common at all time points for vitamin A (29%-36% of patients), vitamin D (21%-37%), vitamin K (10%-22%), and vitamin E (16%-18%). Vitamin levels were inversely correlated with serum TB levels. Biochemical FSV insufficiency was much more common (15%-100% for the different vitamins) in infants whose TB was ≥2 mg/dL. At 3 and 6 months post HPE, only 3 of 24 and 0 of 23 infants, respectively, with TB >2 mg/dL were sufficient in all FSV.
CONCLUSIONS: Biochemical FSV insufficiency is commonly observed in infants with BA and persistent cholestasis despite administration of a TPGS containing liquid multiple FSV preparation. Individual vitamin supplementation and careful monitoring are warranted in infants with BA, especially those with TB >2 mg/dL.
Authors:
Benjamin L Shneider; John C Magee; Jorge A Bezerra; Barbara Haber; Saul J Karpen; Trivellore Raghunathan; Philip Rosenthal; Kathleen Schwarz; Frederick J Suchy; Nanda Kerkar; Yumirle Turmelle; Peter F Whitington; Patricia R Robuck; Ronald J Sokol;
Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2012-08-13
Journal Detail:
Title:  Pediatrics     Volume:  130     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-03     Completed Date:  2012-11-09     Revised Date:  2014-07-02    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e607-14     Citation Subset:  AIM; IM    
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00294684
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MeSH Terms
Descriptor/Qualifier:
Avitaminosis / blood,  drug therapy*,  etiology
Biliary Atresia / complications*,  surgery
Bilirubin / blood
Dietary Supplements*
Double-Blind Method
Female
Humans
Infant
Male
Polyethylene Glycols / therapeutic use
Portoenterostomy, Hepatic
Postoperative Care
Retinol-Binding Proteins / analysis
Vitamin A / blood
Vitamin D / analogs & derivatives,  blood
Vitamin E / analogs & derivatives*,  blood,  therapeutic use
Vitamin K / therapeutic use*
alpha-Tocopherol / blood
Grant Support
ID/Acronym/Agency:
5M01 RR00069/RR/NCRR NIH HHS; DK 62436/DK/NIDDK NIH HHS; DK 62445/DK/NIDDK NIH HHS; DK 62452/DK/NIDDK NIH HHS; DK 62453/DK/NIDDK NIH HHS; DK 62456/DK/NIDDK NIH HHS; DK 62466/DK/NIDDK NIH HHS; DK 62470/DK/NIDDK NIH HHS; DK 62481/DK/NIDDK NIH HHS; DK 62497/DK/NIDDK NIH HHS; DK 62500/DK/NIDDK NIH HHS; DK 62530/DK/NIDDK NIH HHS; U01 DK062453/DK/NIDDK NIH HHS; U01 DK062470/DK/NIDDK NIH HHS; UL1 RR024153/RR/NCRR NIH HHS; UL1 TR000077/TR/NCATS NIH HHS; UL1 TR000448/TR/NCATS NIH HHS; UL1 TR000454/TR/NCATS NIH HHS; UL1RR024131/RR/NCRR NIH HHS; UL1RR024134/RR/NCRR NIH HHS; UL1RR024153/RR/NCRR NIH HHS; UL1RR024992/RR/NCRR NIH HHS; UL1RR025005/RR/NCRR NIH HHS; UL1RR025741/RR/NCRR NIH HHS; UL1RR025780/RR/NCRR NIH HHS; UL1RR026314/RR/NCRR NIH HHS; UL1RR029877/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Polyethylene Glycols; 0/Retinol-Binding Proteins; 11103-57-4/Vitamin A; 12001-79-5/Vitamin K; 1406-16-2/Vitamin D; 1406-18-4/Vitamin E; 64719-49-9/25-hydroxyvitamin D; 9002-96-4/alpha-tocopheryl polyethylene glycol succinate; H4N855PNZ1/alpha-Tocopherol; RFM9X3LJ49/Bilirubin
Comments/Corrections

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