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Aminosyn PF or trophamine: which provides more protection from cholestasis associated with total parenteral
M L Forchielli1, K M Gura, R Sandler
1Combined Program in Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts, USA.
Insights
This study reviewed 70 infants receiving total parenteral nutrition (TPN) to assess amino acid formulations for preventing cholestasis associated with TPN (CATPN). Results indicate TPN duration, not specific formulas like Aminosyn PF or Trophamine, significantly impacts CATPN development.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Cholestasis is a common complication in infants requiring long-term total parenteral nutrition (TPN).
- Specific infant amino acid formulations, Aminosyn PF and Trophamine, are hypothesized to prevent cholestasis associated with TPN (CATPN).
- Other factors like prematurity, sepsis, surgery, and ECMO can also contribute to cholestasis in infants.
Purpose of the Study:
- To compare the effectiveness of Aminosyn PF and Trophamine in preventing CATPN in infants.
- To identify risk factors associated with the development of CATPN.
Main Methods:
- Retrospective review of 70 infants under one year old receiving TPN for at least 14 days.
- Cholestasis defined as conjugated serum bilirubin ≥ 2 mg/dl; CATPN diagnosed after excluding other causes.
- Liver function tests monitored at baseline and on days 7, 15, and 21 of TPN; regression analysis used for risk factor evaluation.
Main Results:
- 30 infants (42.8%) developed cholestasis; 15 (21.4%) had CATPN, and 15 (21.4%) had cholestasis from other causes.
- Among 15 CATPN cases, 7 received Trophamine, 6 received Aminosyn PF, and 2 received both.
- Only the duration of TPN was a statistically significant factor (p=0.0063) in developing CATPN.
Conclusions:
- The study could not confirm that Trophamine is more effective than Aminosyn PF in preventing CATPN.
- TPN duration emerged as a significant risk factor for developing CATPN in infants.
- Further research may be needed to fully elucidate preventative strategies for CATPN.
Abstract:
Cholestasis often occurs in infants on total parenteral nutrition (TPN) for long periods. Amino acid formulations developed specifically for infants, namely Aminosyn PF and Trophamine, may protect against cholestasis associated with total parenteral nutrition (CATPN). The development of cholestasis may also be caused by other risk factors such as prematurity, surgery, sepsis, and extracorporeal membrane oxygenation (ECMO). To evaluate the relative effectiveness of the pediatric amino acid formulations in reducing CATPN, the courses of 70 infants < 1 year of age who received TPN for at least 14 days were reviewed. Cholestasis was defined as a conjugated serum bilirubin > or = 2 mg/dl subsequent to the initiation of TPN; CATPN was considered present when other factors related to cholestasis were ruled out. Liver function tests were recorded 24 h before starting TPN and at day 7, 15, and 21 during TPN infusion. Thirty infants (42.8%) developed cholestasis. CATPN was judged to have occurred in 15 (21.4%) of 70 infants, while 15 (21.4%) developed cholestasis secondary to other factors. Of the 15 CATPN patients, 7 had received Trophamine, 6 had received Aminosyn PF, and 2 had received both solutions. Aminosyn PF and Trophamine, along with other potential risk factors for CATPN such as antecedent surgery, sepsis, ECMO, prematurity, and nitrogen/calorie intake were analyzed by regression-analysis methods. None was statistically significant except the length of TPN (p = 0.0063). In conclusion, we cannot support the view that Trophamine is more effective than Aminosyn PF in the prevention of CATPN.