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Parenteral nutrition-associated liver disease: a retrospective study of ursodeoxycholic Acid use in neonates
Maxime Thibault1, Jessica McMahon1, Guillaume Faubert1
1Department of Pharmacy, CHU Sainte-Justine, Montreal, Canada.
Insights
Ursodeoxycholic acid (UDCA) did not affect the duration of liver disease in neonates receiving parenteral nutrition. However, UDCA was linked to faster bilirubin decline and improved weight gain, possibly due to delayed treatment initiation.
Area of Science:
- Neonatalogy
- Hepatology
- Pharmacology
Background:
- Parenteral nutrition-associated liver disease (PNALD) is a significant complication in neonates.
- Ursodeoxycholic acid (UDCA) is explored as a potential therapeutic agent for PNALD.
Purpose of the Study:
- To investigate the impact of ursodeoxycholic acid (UDCA) on the duration of neonatal parenteral nutrition-associated liver disease (PNALD).
Main Methods:
- A retrospective cohort study was conducted on neonates in intensive care units from 2004 to 2007.
- Infants diagnosed with PNALD were analyzed, comparing those who received UDCA with those who did not.
Main Results:
- Cholestasis duration was longer in the UDCA group (79 days) compared to the non-UDCA group (50 days), though treatment was initiated significantly later in the UDCA group.
- Multivariate analysis revealed no association between UDCA and cholestasis duration.
- UDCA treatment correlated with a faster decline in conjugated bilirubin and greater weight gain in neonates.
Conclusions:
- Ursodeoxycholic acid (UDCA) therapy was not associated with a shorter duration of parenteral nutrition-associated liver disease (PNALD).
- Delayed initiation of UDCA treatment may have influenced the observed outcomes.
- UDCA demonstrated benefits in terms of faster bilirubin clearance and enhanced weight gain in this neonatal cohort.
Objectives:
To verify the effect of ursodeoxycholic acid (UDCA) on the duration of neonatal parenteral nutrition-associated liver disease.
Methods:
Retrospective cohort study of neonates in intensive care between 2004 and 2007 presenting with parenteral nutrition-associated liver disease.
Results:
Of 118 eligible infants, 64 received UDCA. Cholestasis lasted longer in the UDCA group (79 vs. 50 days, p=0.001). However, treatment was delayed for a median of 24 days after cholestasis onset. Multivariate Cox regression analysis showed no association between UDCA and cholestasis duration. The rate of decline of conjugated bilirubin was greater in treated patients (median 0.084 mg/dL/day vs. 0.60 mg/dL/day; p=0.009) and weight gain was greater (22.8 vs. 17.7 g/kg/day, p=0.010).
Conclusions:
UDCA therapy was not associated with the duration of parenteral nutrition-associated liver disease. A delay in treatment initiation might explain this result. UDCA therapy was associated with a faster decline of conjugated bilirubin and greater weight gain.
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