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Updated: Aug 19, 2026
Isolation of Neonatal Extrahepatic Cholangiocytes
Published on: June 5, 2014
Plasma conjugated cholic acid in premature and term newborns and young infants
Insights
Neonates, especially premature infants, have higher plasma conjugated cholic acid (CCA) levels. Post-feed CCA rises quickly but returns slowly in premature babies, suggesting caution when interpreting bile acid levels in early infancy.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Bile Acid Metabolism
Background:
- Bile acid handling undergoes significant changes from infancy to adulthood.
- Understanding neonatal bile acid physiology is crucial for interpreting clinical measurements.
Purpose of the Study:
- To assess bile acid handling in premature, full-term neonates, and 3-month-old infants.
- To characterize plasma conjugated cholic acid (CCA) concentrations before and after feeding across different infant groups.
Main Methods:
- Measured plasma CCA concentrations in four groups: premature neonates (Groups I & II), full-term neonates (Group III), and 3-month-old infants (Group IV).
- Assessed pre-feeding and post-feeding (at intervals) CCA levels to evaluate handling and clearance.
Main Results:
- Pre-feeding CCA concentrations were highest in the most premature infants (Group I) and decreased with maturity.
- Postprandial CCA increments correlated with gestational age, with rapid rises peaking at 30 minutes post-feed.
- CCA levels returned to baseline faster in more mature infants (Groups II-IV) compared to the most premature (Group I).
Conclusions:
- Rapid postprandial CCA increases in neonates may be influenced by factors like passive jejunal absorption and immature hepatic clearance.
- Plasma bile acid measurements are less suitable for detecting disturbed ileal function in young infants due to physiological variations.
- Elevated CCA levels in healthy newborns necessitate caution when interpreting these values, particularly in premature infants.
Abstract:
Bile acid handling by neonates, both premature (Group I, mean gestational age 34.3 weeks; Group II, 36.6 weeks) and full-term (Group III, 40.2 weeks) and by 3-month-old infants (Group IV) was assessed by measuring plasma concentrations of conjugated cholic acid (CCA) before and at successive intervals after feeds. The prefeeding CCA concentrations were highest in Group I (log mean 8.2; range 1.8--28.6 mumol/l) and lower in Groups II (7.5; 2.6--22.4 mumol/l), III (5.1; 2.1--11.1 mumol/L), and IV (2.2; 0.5--6.1 mumol/l). The mean postprandial increments correlated with maturity: the rises for Groups I--IV were 3.7, 4.3, 1.0 and 0.7 mumol/l, respectively. Peak values were consistently reached at 30 min after the start of the feed, i.e. strikingly earlier than in older children and adults. After the peaks the return to prefeeding levels occurred rapidly in Groups II--Iv but more slowly in the most premature infants (Group I). The rapid postprandial rise may be due to many factors, e.g., passive jejunal absorption, immature hepatic clearing mechanisms, or rapid transit of bile acids to the ileum. Hence, measurements of postprandial plasma bile acids would appear ill-suited for detection of disturbed ileal function in young infants. The high concentrations in healthy newborns suggest that caution is necessary in interpreting plasma bile acid concentrations during the first few weeks of life, especially in premature infants.
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