Document Detail


High rates of mortality and morbidity occur in infants with parenteral nutrition-associated cholestasis.
MedLine Citation:
PMID:  19587385     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Extremely few data are available about the natural history of parenteral nutrition (PN)-associated cholestasis. The authors evaluated a cohort of infants at a large center to determine the outcome of PN-associated cholestasis in infants with some gastrointestinal function. METHODS: The authors reviewed the records of all infants admitted to a level 3 neonatal intensive care unit over a 16-month period who had the diagnosis of PN-associated cholestasis. Records were reviewed in these infants for course of cholestasis, laboratory values, outcome, and infection rate. RESULTS: Sixty-six patients were admitted who met the study criteria. There were 10 deaths and 1 referral for liver transplant (Death/TPlant) (17%) in the first year of life. All Death/TPlant infants had at least 1 positive blood culture after the onset of cholestasis. Maximum conjugated bilirubin (MaxCB) in Death/TPlant infants was 15.7 +/- 2.2 (SEM) compared to 8.4 +/- 1.0 mg/dL in babies who recovered. Of 21 infants with a MaxCB > or =10.0, Death/TPlant occurred in 8/21 (38%). Of 40 babies with positive blood cultures, 11 were in the Death/TPlant group vs no deaths among the 25 without positive blood cultures. Average time to resolution from the MaxCB to a CB <2.0 mg/dL was 66 +/- 7 days (n = 49). CONCLUSIONS: Infants with PN-associated cholestasis have high rates of mortality despite the presence of some gastrointestinal function. These data support further evaluation and the development of novel forms of therapy for babies with parenteral-associated CB > or =2 mg/dL with emphasis on interventions for infants with a CB >10 mg/dL.
Authors:
Theresa C Willis; Beth A Carter; Stefanie P Rogers; Keli M Hawthorne; Penni D Hicks; Steven A Abrams
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2009-07-08
Journal Detail:
Title:  JPEN. Journal of parenteral and enteral nutrition     Volume:  34     ISSN:  0148-6071     ISO Abbreviation:  JPEN J Parenter Enteral Nutr     Publication Date:    2010 Jan-Feb
Date Detail:
Created Date:  2010-01-07     Completed Date:  2010-05-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7804134     Medline TA:  JPEN J Parenter Enteral Nutr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  32-7     Citation Subset:  IM    
Affiliation:
United States Department of Agriculture/Agricultural Research Service, Children's Nutrition Research Center and Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
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MeSH Terms
Descriptor/Qualifier:
Bilirubin / blood
Cholagogues and Choleretics / therapeutic use
Cholestasis / blood,  etiology,  mortality*
Humans
Incidence
Infant
Infant, Newborn
Infection / etiology
Intestinal Diseases / therapy
Liver Transplantation
Parenteral Nutrition / adverse effects*
Ursodeoxycholic Acid / therapeutic use
Chemical
Reg. No./Substance:
0/Cholagogues and Choleretics; 128-13-2/Ursodeoxycholic Acid; 635-65-4/Bilirubin
Comments/Corrections
Comment In:
JPEN J Parenter Enteral Nutr. 2010 Jan-Feb;34(1):94-5   [PMID:  19407103 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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