Copper supplementation in parenteral nutrition of cholestatic infants

Conventional practice is to reduce or eliminate copper (Cu) supplementation in the parenteral nutrition of infants with cholestasis because of the increased risk of hepatotoxicity. However, there are reports of Cu deficiency in cholestatic infants because of Cu reduction in their parenteral nutrition. The objectives of the present study are to determine the proportion of cholestatic infants who develop elevated serum Cu while receiving a nonreduced dose of parenteral Cu, to evaluate potential clinical factors that affect serum Cu in cholestatic infants, and to evaluate the impact of serum Cu on liver disease.

This is a retrospective review of 28 cholestatic infants receiving 20 microg x kg(-1) x day(-1) of Cu via parenteral nutrition. Age-adjusted references were used to determine normality of serum Cu levels. Multiple linear regression analyses were performed to determine predictors of serum Cu and alanine aminotransferase (ALT).

Serum Cu levels were elevated in 2 infants (7%). On average, infants received 80% of their energy intake from parenteral nutrition for 3 months. Intestinal failure was present in 50% of the patients. Birth weight, gestational age, and ALT were identified as predictors of serum Cu (R2 = 0.53; P = 0.0001). Serum Cu, gestational age, and total bilirubin were associated with serum ALT (R2 = 0.43; P = 0.001).

Supplementation of parenteral Cu at 20 microg x kg(-1) x day(-1) does not lead to a significant increase in Cu toxicity or worsening of liver disease in cholestatic infants.