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Hyperalimentation-associated neonatal cholestasis: effect of oral gentamicin
S G Spurr1, L J Grylack, N R Mehta
1Division of Neonatology, Columbia Hospital for Women, Washington D.C. 20007.
Insights
Oral gentamicin may protect preterm infants from parenteral nutrition-associated cholestasis. This study found lower bilirubin levels and cholestasis incidence in infants receiving oral gentamicin for necrotizing enterocolitis prevention.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Pharmacology
Background:
- Parenteral nutrition (PN) is essential for preterm infants but can cause cholestasis.
- Neonatal necrotizing enterocolitis (NEC) is a serious complication in preterm infants.
- Oral gentamicin is used for NEC prophylaxis.
Purpose of the Study:
- To assess the effect of oral gentamicin on PN-associated cholestasis in preterm infants.
- To investigate the relationship between gentamicin prophylaxis and liver function in neonates receiving PN.
Main Methods:
- Retrospective study of 24 preterm infants (<1500 g) on PN for >10 days.
- Comparison of 12 infants receiving oral gentamicin (Group I) versus 12 not receiving it (Group II).
- Analysis of mean and peak direct bilirubin levels and incidence of cholestasis.
Main Results:
- Group II (no gentamicin) had significantly higher mean and peak direct bilirubin levels.
- Significant increase in bilirubin levels post-PN initiation was observed only in Group II.
- The incidence of cholestasis was significantly higher in Group II compared to Group I.
Conclusions:
- Oral gentamicin may offer a protective effect against PN-associated cholestasis in preterm infants.
- Gentamicin prophylaxis could be a strategy to mitigate liver complications in neonates requiring PN.
Abstract:
The effect of oral gentamicin on the incidence of parenteral nutrition-associated cholestasis in preterm infants less than 1500 g birth weight was assessed retrospectively. Of 24 patients on parenteral nutrition for more than 10 days, 12 infants who received oral gentamicin (group I) for prophylaxis against neonatal necrotizing enterocolitis were compared to 12 infants who did not (group II). Both mean and peak direct bilirubin levels were significantly higher in group II. The increase in both mean and peak direct bilirubin levels after initiation of total parenteral nutrition (TPN) was significant in group II only. The incidence of cholestasis was significantly higher in group II than in group I. These results suggest that oral gentamicin may have a protective effect against parenteral nutrition-associated cholestasis in the newborn preterm infant.