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Published on: September 20, 2019
Recovery from parenteral nutrition-associated cholestasis takes approximately two months in very low birth weight
Keun Hyun Oh1, Yoonkyo Oh1, Gina Lim1
1Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
Insights
Parenteral nutrition-associated cholestasis (PNAC) affects 13.2% of very low birth weight infants, leading to prolonged liver enzyme elevation. Early-onset PNAC indicates a more severe course and longer recovery time.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Parenteral nutrition-associated cholestasis (PNAC) is a significant complication in very low birth weight (VLBW) infants.
- Understanding the clinical course and characteristics of PNAC is crucial for optimizing infant care.
Purpose of the Study:
- To investigate the clinical characteristics and course of PNAC in VLBW infants.
- To compare infants with and without PNAC and analyze factors influencing PNAC onset and severity.
Main Methods:
- Retrospective chart review of VLBW infants.
- Comparison of clinical characteristics between infants with and without PNAC.
- Analysis of liver enzyme trends and PNAC characteristics based on age of onset.
Main Results:
- PNAC was observed in 13.2% of eligible VLBW infants, associated with lower gestational age, birth weight, and adverse outcomes.
- PNAC onset, peak direct bilirubin, and resolution occurred at specific postnatal ages, with prolonged liver enzyme elevation (AST, ALT) even after discontinuing PN.
- Early-onset PNAC was linked to longer PN duration, higher peak direct bilirubin, and higher peak AST levels.
Conclusions:
- Elevated direct bilirubin, AST, and ALT can persist long after parenteral nutrition cessation.
- A cautious approach with reduced frequency of repetitive examinations is suggested for managing PNAC.
- Further research may elucidate optimal management strategies for PNAC in VLBW infants.
Aim:
To investigate the clinical characteristics and course of parenteral nutrition-associated cholestasis (PNAC) in very low birth weight (VLBW) infants.
Methods:
The charts of VLBW infants were retrospectively reviewed. The clinical characteristics of infants with and without PNAC were compared, trends in liver enzymes were investigated, and the characteristics of infants with PNAC were analysed based on age of onset.
Results:
PNAC was observed in 53 (13.2%) of 403 infants who survived and completed follow-up and was associated with significantly lower gestational age, birth weight, and adverse neonatal outcomes. PNAC started at a median 32 (interquartile range 23-47) days, PN was applied for 53 (34.5-64.5) days, the maximum direct bilirubin (DB) was observed at 63 (50-76) postnatal days, and PNAC resolved at 94 (79-122) postnatal days postnatal age. PNAC lasted 61 (38-89.5) days. AST and ALT normalised at 111 (100.3-142.0) and 109.5 (97-161.3) postnatal days. Infants with early-onset PNAC had significantly longer PN duration, higher maximum DB, and higher maximum AST than those with late-onset PNAC.
Conclusion:
Elevated DB, AST, and ALT persist for a long period after discontinuing PN. We suggest a cautious approach that involves waiting and reducing the frequency of additional repetitive examinations.
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