Yonsei Med J.  2013 Jul;54(4):839-844. 10.3349/ymj.2013.54.4.839.

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

• Lee SM
• Namgung R
• Park MS
• Eun HS
• Kim NH
• Park KI
• Lee C

• KMID: 2158216
• DOI: http://doi.org/10.3349/ymj.2013.54.4.839

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.

Keyword

Parenteral nutrition associated cholestasis; small for gestational age; appropriate for gestational age; hepatic dysfunction

MeSH Terms

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
Bilirubin

Figure

• 

  Fig. 1 Comparison of serum total bilirubin (A) and direct bilirubin (B) levels from SGA and AGA infants with PNAC. There was a significant difference in the serum levels of total bilirubin (p<0.01) and direct bilirubin (p<0.01) levels of SGA infants compared with AGA infants by repeated measured ANOVA. SGA, small for gestational age; AGA, appropriate for gestational age; PNAC, parenteral nutrition associated cholestasis; ANOVA, analysis of variance.

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