Cholestasis affects enteral tolerance and prospective weight gain in the NICU.
Bilirubin
Birth Weight
Cholagogues and Choleretics
/ therapeutic use
Cholestasis
/ complications
Digestive System Surgical Procedures
/ adverse effects
Disease Progression
Fat Emulsions, Intravenous
/ administration & dosage
Female
Fibrosis
/ prevention & control
Fish Oils
/ administration & dosage
Humans
Hyperbilirubinemia
/ physiopathology
Infant
Infant Nutritional Physiological Phenomena
Infant, Newborn
Infant, Premature
Intensive Care Units, Neonatal
Male
Parenteral Nutrition
/ adverse effects
Postoperative Complications
/ physiopathology
Prognosis
Retrospective Studies
Ursodeoxycholic Acid
/ therapeutic use
Weight Gain
Cholestasis
Neonates
Nutrition
Journal
Clinical nutrition ESPEN
ISSN: 2405-4577
Titre abrégé: Clin Nutr ESPEN
Pays: England
ID NLM: 101654592
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
received:
08
01
2019
accepted:
15
01
2019
entrez:
25
3
2019
pubmed:
25
3
2019
medline:
30
7
2020
Statut:
ppublish
Résumé
Intestinal Failure-Associated Liver Disease is characterized by cholestasis and hepatic dysfunction due to parenteral nutrition (PN) therapy. We described key features of cholestatic infants receiving PN to assess overall outcomes in this population at our institution. This is a retrospective single center study of 163 neonates grouped into cholestatic (n = 63) and non-cholestatic (n = 100) as defined by peak conjugated bilirubin of ≥2.0 mg/dL or < 0.8 mg/dL, respectively. Univariate and multiple regression models were used to study associations between variables and outcomes of interest. Lower Apgar scores (4 ± 3 vs. 6 ± 3, p-value = <0.005 at 1 min; 6 ± 2 vs. 7 ± 2, p < 0.005 at 5 min) and lower birth weight (adj β [SE] = 0.62 [0.27], p-value = 0.024) were risk factors for developing cholestasis. Cholestatic infants were more likely to have had gastrointestinal surgery (31 [49%] vs. 15 [15%], p-value <0.005), received PN for a longer duration (40 ± 39 days vs. 11 ± 7 days, p-value <0.005), and started enteral feeds later in life (86 ± 23 days vs. 79 ± 20 days, p-value <0.005) when compared to non-cholestatic infants. Weight percentiles in cholestatic infants were lower both at hospital discharge (14 ± 19 vs. 24 ± 22, p-value <0.005) and at 6 months of age (24 ± 28 vs. 36 ± 31, p-value = 0.05). Cholestasis in the NICU is a multifactorial process, but it has a long lasting effect on prospective weight gain in infants who receive PN in the NICU. This finding highlights the importance of follow-up for adequate growth and the potential benefit from aggressive nutritional support.
Sections du résumé
BACKGROUND
Intestinal Failure-Associated Liver Disease is characterized by cholestasis and hepatic dysfunction due to parenteral nutrition (PN) therapy. We described key features of cholestatic infants receiving PN to assess overall outcomes in this population at our institution.
METHODS
This is a retrospective single center study of 163 neonates grouped into cholestatic (n = 63) and non-cholestatic (n = 100) as defined by peak conjugated bilirubin of ≥2.0 mg/dL or < 0.8 mg/dL, respectively. Univariate and multiple regression models were used to study associations between variables and outcomes of interest.
RESULTS
Lower Apgar scores (4 ± 3 vs. 6 ± 3, p-value = <0.005 at 1 min; 6 ± 2 vs. 7 ± 2, p < 0.005 at 5 min) and lower birth weight (adj β [SE] = 0.62 [0.27], p-value = 0.024) were risk factors for developing cholestasis. Cholestatic infants were more likely to have had gastrointestinal surgery (31 [49%] vs. 15 [15%], p-value <0.005), received PN for a longer duration (40 ± 39 days vs. 11 ± 7 days, p-value <0.005), and started enteral feeds later in life (86 ± 23 days vs. 79 ± 20 days, p-value <0.005) when compared to non-cholestatic infants. Weight percentiles in cholestatic infants were lower both at hospital discharge (14 ± 19 vs. 24 ± 22, p-value <0.005) and at 6 months of age (24 ± 28 vs. 36 ± 31, p-value = 0.05).
CONCLUSIONS
Cholestasis in the NICU is a multifactorial process, but it has a long lasting effect on prospective weight gain in infants who receive PN in the NICU. This finding highlights the importance of follow-up for adequate growth and the potential benefit from aggressive nutritional support.
Identifiants
pubmed: 30904211
pii: S2405-4577(18)30724-1
doi: 10.1016/j.clnesp.2019.01.006
pmc: PMC8375631
mid: NIHMS1696432
pii:
doi:
Substances chimiques
Cholagogues and Choleretics
0
Fat Emulsions, Intravenous
0
Fish Oils
0
Ursodeoxycholic Acid
724L30Y2QR
Bilirubin
RFM9X3LJ49
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
119-125Subventions
Organisme : NIDDK NIH HHS
ID : K23 DK117061
Pays : United States
Informations de copyright
Copyright © 2019 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.
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