Related Experiment Videos
Measuring bile-salt concentrations lacks clinical value for detecting hepatic dysfunction in infants receiving
Insights
In low-birthweight infants receiving parenteral nutrition, hepatic dysfunction presents two biochemical patterns. Direct bilirubin is a reliable marker for detecting liver issues, offering no advantage over bile salt measurements.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Biochemistry
Background:
- Parenteral nutrition (PN) is essential for low-birthweight infants but can lead to hepatic dysfunction.
- Early detection of PN-induced liver injury is crucial for timely intervention.
Purpose of the Study:
- To investigate biochemical patterns of hepatic dysfunction in low-birthweight infants receiving PN.
- To compare the diagnostic utility of direct bilirubin and bile salt measurements in these infants.
Main Methods:
- Plasma concentrations of conjugated cholate, chenodeoxycholate, direct bilirubin, and alanine aminotransferase (ALT) were measured.
- Infants were categorized into two biochemical patterns based on marker changes.
- Hepatic dysfunction was monitored until resolution.
Main Results:
- 15% of infants developed hepatic dysfunction, exhibiting two patterns: Type A (elevated direct bilirubin and bile salts, normal ALT) and Type B (elevated direct bilirubin and bile salts, followed by elevated ALT).
- Type B pattern was associated with prolonged hepatic dysfunction and higher maximal direct bilirubin concentrations.
- No significant difference was found in the timing of abnormal or normalizing marker values between the two patterns.
Conclusions:
- Direct bilirubin measurement is as effective as bile salt measurement for detecting PN-induced hepatic dysfunction in neonates.
- The two identified biochemical patterns may indicate different severities or progression rates of liver injury.
Abstract:
Concentrations of conjugated cholate, chenodeoxycholate, direct bilirubin, and alanine aminotransferase (ALT, EC 2.6.1.2) were measured in plasma of 122 low-birthweight infants receiving parenteral nutrition. Eighteen (15%) of them developed hepatic dysfunction. We observed two distinct biochemical patterns in these infants. In the Type A pattern (12 infants), concentrations of direct-reading bilirubin and bile salts increased with no change in ALT activity. In the Type B pattern (six infants), increases in the concentrations of bile salt and direct bilirubin were followed by increases in ALT activity. Hepatic dysfunction persisted significantly longer in infants who developed the Type B pattern. The two patterns did not differ significantly in the times at which values for bile salts or direct bilirubin in plasma became abnormal or became normal at resolution, nor did maximal concentrations of bile salts in plasma differ significantly. Maximal concentrations of direct bilirubin were higher in the Type B infants. We conclude that, in such infants, measurement of bile-salt concentrations in plasma offers no advantages for detecting hepatic dysfunction over the more conventional measurement of direct bilirubin in plasma.