Direct hyperbilirubinemia in newborns with gastroschisis.
Cholestasis
Direct hyperbilirubinemia
Gastroschisis
Outcomes
Resource utilization
Journal
Pediatric surgery international
ISSN: 1437-9813
Titre abrégé: Pediatr Surg Int
Pays: Germany
ID NLM: 8609169
Informations de publication
Date de publication:
Mar 2019
Mar 2019
Historique:
accepted:
02
11
2018
pubmed:
12
11
2018
medline:
23
4
2019
entrez:
12
11
2018
Statut:
ppublish
Résumé
Patients with gastroschisis and prolonged total (or partial) parenteral nutrition (PN) commonly develop direct hyperbilirubinemia (DH). To quantify the prevalence and severity of DH in newborns with gastroschisis and characterize the diagnostic work-up for DH in this patient population. Retrospective chart review of patients born with gastroschisis between 2005 and 2015 for the first 6 months of life. 29 patients were identified with gastroschisis. Mean gestational age and birthweight were 36.4 (± 1.8) weeks and 2.5 (± 0.6) kg. 41% were treated with primary reduction versus staged closure. Peak total and direct bilirubin (DB) levels were 10.17 ± 6.21 mg/dL and 5.58 ± 3.94 mg/dL, respectively. 23 patients (79.3%) were diagnosed with DH and 78.2% underwent additional work-up for hyperbilirubinemia consisting of imaging and laboratory studies, none of which revealed a cause for DH other than the presumed PN-associated cholestasis. In all patients, DB began to decline within 1-10 days of initiation of enteral feeds. DH is common in patients with gastroschisis and is unlikely to be associated with pathology aside from PN. Additional work-up may lead to unnecessary resource utilization. Case series with no comparison group, Level IV.
Sections du résumé
BACKGROUND
BACKGROUND
Patients with gastroschisis and prolonged total (or partial) parenteral nutrition (PN) commonly develop direct hyperbilirubinemia (DH).
OBJECTIVE
OBJECTIVE
To quantify the prevalence and severity of DH in newborns with gastroschisis and characterize the diagnostic work-up for DH in this patient population.
DESIGN/METHODS
METHODS
Retrospective chart review of patients born with gastroschisis between 2005 and 2015 for the first 6 months of life.
RESULTS
RESULTS
29 patients were identified with gastroschisis. Mean gestational age and birthweight were 36.4 (± 1.8) weeks and 2.5 (± 0.6) kg. 41% were treated with primary reduction versus staged closure. Peak total and direct bilirubin (DB) levels were 10.17 ± 6.21 mg/dL and 5.58 ± 3.94 mg/dL, respectively. 23 patients (79.3%) were diagnosed with DH and 78.2% underwent additional work-up for hyperbilirubinemia consisting of imaging and laboratory studies, none of which revealed a cause for DH other than the presumed PN-associated cholestasis. In all patients, DB began to decline within 1-10 days of initiation of enteral feeds.
CONCLUSION(S)
CONCLUSIONS
DH is common in patients with gastroschisis and is unlikely to be associated with pathology aside from PN. Additional work-up may lead to unnecessary resource utilization.
LEVELS OF EVIDENCE
METHODS
Case series with no comparison group, Level IV.
Identifiants
pubmed: 30415437
doi: 10.1007/s00383-018-4415-1
pii: 10.1007/s00383-018-4415-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
293-301Références
Semin Pediatr Surg. 1999 Aug;8(3):140-7
pubmed: 10461327
CMAJ. 2002 Jun 25;166(13):1663-71
pubmed: 12126320
Pediatrics. 2003 Dec;112(6 Pt 1):1264-73
pubmed: 14654595
J Pediatr Gastroenterol Nutr. 2004 Aug;39(2):115-28
pubmed: 15269615
J Nucl Med. 2004 Sep;45(9):1488-92
pubmed: 15347715
Eur J Pediatr Surg. 2005 Dec;15(6):434-6
pubmed: 16418964
Acta Paediatr. 2007 Jan;96(1):73-5
pubmed: 17187608
J Pediatr Surg. 2007 May;42(5):806-11
pubmed: 17502188
Transplant Proc. 2007 Jun;39(5):1632-3
pubmed: 17580205
Clin Liver Dis. 2008 Feb;12(1):97-110, viii
pubmed: 18242499
Acta Paediatr. 2008 Jun;97(6):751-3
pubmed: 18397350
J Pediatr Surg. 2009 Jan;44(1):183-9
pubmed: 19159741
Semin Nucl Med. 2009 May;39(3):174-85
pubmed: 19341837
J Pediatr Surg. 2012 Jan;47(1):225-40
pubmed: 22244423
J Pediatr Surg. 2012 Aug;47(8):1529-36
pubmed: 22901912
J Pediatr. 2013 Mar;162(3):477-482.e1
pubmed: 23043681
J Pediatr Surg. 2013 May;48(5):971-6
pubmed: 23701769
JPEN J Parenter Enteral Nutr. 2014 Jan;38(1):70-85
pubmed: 23894170
Turk J Gastroenterol. 2013;24(5):406-14
pubmed: 24557964
J Pediatr Pharmacol Ther. 2014 Jan;19(1):42-8
pubmed: 24782691
J Pediatr Gastroenterol Nutr. 2014 Dec;59(6):695-701
pubmed: 25141230
Obstet Gynecol. 2014 Sep;124(3):551-7
pubmed: 25162255
Clin Med Insights Pediatr. 2015 Feb 09;9:25-36
pubmed: 25698888
J Pediatr Surg. 2015 Mar;50(3):363-70
pubmed: 25746690
BMC Pediatr. 2015 Nov 20;15:192
pubmed: 26589959
Clin Liver Dis. 2016 Feb;20(1):159-76
pubmed: 26593297
J Pediatr. 2016 Mar;170:85-9
pubmed: 26703875
J Pediatr (Rio J). 2016 May-Jun;92(3):268-75
pubmed: 26844392
Nutr Clin Pract. 2016 Oct;31(5):647-53
pubmed: 27143651
Clin Perinatol. 2016 Jun;43(2):355-73
pubmed: 27235213
Iran J Public Health. 2016 May;45(5):558-68
pubmed: 27398328
J Pediatr Gastroenterol Nutr. 2017 Jan;64(1):154-168
pubmed: 27429428
J Perinatol. 2017 May;37(5):536-540
pubmed: 28125097
J Pediatr Surg. 2018 Mar;53(3):513-520
pubmed: 28483165
Clin Res Hepatol Gastroenterol. 2018 Sep;42(4):368-377
pubmed: 29551613
Arch Dis Child. 1970 Dec;45(244):800-4
pubmed: 5491884
JPEN J Parenter Enteral Nutr. 1983 Jan-Feb;7(1):21-5
pubmed: 6403729
Semin Nucl Med. 1981 Jul;11(3):194-204
pubmed: 7280702
Am J Surg. 1996 Jun;171(6):587-90
pubmed: 8678205
JPEN J Parenter Enteral Nutr. 1995 Nov-Dec;19(6):453-60
pubmed: 8748359
Res Exp Med (Berl). 1998 Dec;198(4):207-13
pubmed: 9879599