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Parenteral nutrition-associated cholestasis in preterm neonates: evaluation of ursodeoxycholic acid treatment
1Division of Gastroenterology and Nutrition, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
Insights
Ursodeoxycholic acid (UDCA) is safe for premature infants with parenteral nutrition-associated cholestasis, showing early bilirubin decreases. However, transaminase improvements were not sustained in this small study.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Hepatology
Background:
- Parenteral nutrition (PN) is crucial for premature infants but can cause cholestatic liver disease.
- Ursodeoxycholic acid (UDCA) is a potential treatment for PN-associated cholestasis in various age groups.
Purpose of the Study:
- To evaluate the efficacy of ursodeoxycholic acid (UDCA) in premature infants experiencing parenteral nutrition-associated cholestasis.
Main Methods:
- Retrospective chart review of infants treated with UDCA for PN-associated cholestasis.
- Assessment of bilirubin, ALT, AST, and ALP levels over at least one month of treatment.
Main Results:
- Six infants received UDCA (15-30 mg/kg/day); cholestasis onset averaged 47 days after 42 days of PN.
- Bilirubin levels decreased in all infants; transaminases showed mixed responses.
- No toxicity was observed; bilirubin improvement correlated with enteral nutrition initiation.
Conclusions:
- UDCA appears safe in premature infants with PN-associated cholestasis.
- UDCA led to an early, sustained decrease in bilirubin levels within two weeks.
- Transaminase response was inconsistent and not sustained in this limited cohort.
Background/Objective:
Parenteral nutrition is an integral part of the care of premature infants. Cholestatic liver disease is a frequent complication of prolonged parenteral nutrition, especially in premature infants. It has been suggested that ursodeoxycholic acid may alter the course of parenteral nutrition-associated cholestasis in children and adults. We attempted to determine the efficacy of ursodeoxycholic acid in premature infants with parenteral nutrition-associated cholestasis.
Methods:
Retrospective chart review of all infants receiving ursodeoxycholic acid for parenteral nutrition-associated cholestasis in a 40 bed neonatal intensive care unit. Efficacy of ursodeoxycholic acid was evaluated by response of bilirubin, alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase over a treatment period of at least 1 month.
Results:
Six infants with parenteral nutrition-associated cholestasis who had received ursodeoxycholic acid for one month were identified. Doses of ursodeoxycholic acid ranged from 15-30 mg/kg/day. Cholestasis appeared at a mean age of 47 +/- 17 (mean +/- SD) days after a mean of 42 +/- 15 days of parenteral nutrition. Transaminase levels decreased in three, and either increased or did not change in the other three infants. Bilirubin levels decreased in all infants. Alkaline phosphatase showed a non significant trend to decreased levels. Consistent improvement in all infants was noted only after 10 days of full enteral nutrition. No toxicity was found during ursodeoxycholic acid treatment.
Conclusions:
Ursodeoxycholic acid treatment in premature infants appears to be safe, and leads to an early sustained decrease in bilirubin levels by two weeks of therapy. The response of transaminase levels was not sustained in our small cohort.