Document Detail

Parenteral nutrition-associated conjugated hyperbilirubinemia in hospitalized infants.
MedLine Citation:
PMID:  21034882     Owner:  NLM     Status:  MEDLINE    
Parenteral nutrition-associated conjugated hyperbilirubinemia (PNAC), commonly defined as direct bilirubin ≥2 mg/dL (34.2 μmol/L), is primarily a pediatric disease with premature infants being the most susceptible. Severe morbidity and increased mortality are associated with bilirubin >10 mg/dL (171.0 μmol/L). The lack of knowledge regarding the cause of PNAC has stymied development of prevention and treatment strategies. A systematic search of published reports was conducted to provide data on histopathology of PNAC and to review prospective, randomized, controlled trials in hospitalized infants. In experiments of young animals, parenteral nutrition (PN) with and without soy oil emulsion is directly linked to hyperbilirubinemia, and the effects are exaggerated by overfeeding. In infants, the most consistently reported risk factor for PNAC is the duration of PN. The only known effective modality is the transition to full enteral feeding and discontinuation of PN. Emerging clinical research is evaluating the role of lipid source (soy vs fish) and motility agents, such as erythromycin. Different trace element preparations are associated with varying severity of cholestasis, a finding that also deserves more study. This article reviews the prevalence, risk factors, clinical presentation, and treatment options for PNAC in neonatal intensive care units.
Catherine J Klein; Mary Revenis; Mary Ravenis; Carolyn Kusenda; Louis Scavo
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of the American Dietetic Association     Volume:  110     ISSN:  1878-3570     ISO Abbreviation:  J Am Diet Assoc     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-01     Completed Date:  2010-11-30     Revised Date:  2011-03-30    
Medline Journal Info:
Nlm Unique ID:  7503061     Medline TA:  J Am Diet Assoc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1684-95     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.
Bionutrition Research Program, Children's National Medical Center, and Department of Pediatrics, School of Washington, DC, USA.
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MeSH Terms
Bilirubin / blood*
Cholestasis / epidemiology,  etiology,  prevention & control,  therapy
Enteral Nutrition
Gestational Age
Hyperbilirubinemia / epidemiology*,  etiology*,  prevention & control,  therapy
Infant, Newborn
Infant, Premature
Intensive Care Units, Neonatal
Parenteral Nutrition / adverse effects*
Risk Factors
Time Factors
Treatment Outcome
Reg. No./Substance:
Erratum In:
J Am Diet Assoc. 2011 Mar;111(3):463
Note: Ravenis, Mary [corrected to Revenis, Mary]

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