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Laboratory monitoring of parenteral nutrition-associated hepatic dysfunction in infants
Insights
Direct bilirubin is the earliest indicator of cholestatic jaundice in infants receiving parenteral nutrition (PN). Monitoring direct bilirubin levels is crucial for assessing liver injury in neonates undergoing PN.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Clinical Biochemistry
Background:
- Hepatic dysfunction is a recognized complication of parenteral nutrition (PN).
- Early detection of liver injury in infants receiving PN is critical for management.
- Existing laboratory markers for monitoring PN-associated liver injury require further evaluation.
Purpose of the Study:
- To define the temporal relationships between direct bilirubin and other liver function tests in neonates receiving PN.
- To identify the most sensitive and earliest laboratory indicator of cholestatic jaundice (ChJ) in this population.
- To evaluate the utility of SGPT, SGOT, and alkaline phosphatase in assessing PN-associated liver injury.
Main Methods:
- Prospective study of 60 neonates receiving PN.
- Weekly measurement of total and direct bilirubin, SGPT, SGOT, and alkaline phosphatase.
- Definition of ChJ as direct bilirubin ≥ 2.0 mg/dl.
Main Results:
- Cholestatic jaundice developed in 33% of infants receiving PN for at least 2 weeks.
- Direct bilirubin was the most sensitive and earliest indicator of ChJ.
- SGOT and SGPT showed significant differences only 2 weeks after ChJ onset; alkaline phosphatase increases were not specific to the ChJ group.
Conclusions:
- Direct bilirubin is the sole reliable laboratory indicator for serial monitoring of hepatic status in infants receiving PN.
- SGPT and SGOT may aid in characterizing hepatic dysfunction post-ChJ onset.
- Alkaline phosphatase is not a reliable marker for PN-associated liver injury.
Abstract:
Hepatic dysfunction associated with parenteral nutrition (PN) is a well recognized occurrence. In order to define the temporal inter-relationships of direct bilirubin to other laboratory parameters, total and direct bilirubin, serum glutamic-pyruvic transaminase (SGPT), serum glutamic-oxaloacetic transaminase (SGOT), and alkaline phosphatase were measured prior to beginning PN and then weekly throughout the duration of PN in 60 consecutive neonates. Cholestatic jaundice (ChJ), defined as a direct bilirubin greater than or equal to 2.0 mg/dl, developed in 11 (33%) of 33 infants receiving PN for at least 2 weeks. Direct bilirubin was the most sensitive and earliest indicator of ChJ. SGOT and SGPT values in the ChJ group were not statistically different from the non-ChJ group until 2 weeks after the onset of cholestasis. Although there was a progressive increase in alkaline phosphatase during the course of PN, the increase was not greater in the ChJ group. In summary, direct bilirubin is the only laboratory indicator of hepatic status that need be determined serially in parenterally alimented infants. Although SGPT and SGOT may be helpful in characterizing hepatic dysfunction once ChJ has occurred, alkaline phosphatase levels do not reliably assess PN-associated liver injury.