Skip to main content

Advertisement

SpringerLink
Log in

Could lipid infusion be a risk for parenteral nutrition-associated cholestasis in low birth weight neonates?

  • Original Paper
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

To assess whether lipid infusion could be a risk factor for parenteral nutrition-associated cholestasis (PNAC) in low birth weight neonates, 22 newborns with cholestasis (29.8 ± 1.6 weeks, 1298 ± 217 g) were compared with 22 without cholestasis (29.5 ± 1.7 weeks, 1286 ± 363 g). The mean level of peak direct bilirubin for the cholestasis group was 4.6 mg/dl compared to 1.2 mg/dl for the noncholestasis group. A univariate analysis revealed that PNAC was significantly related to duration of fasting (p = 0.008) and parenteral nutrition (p < 0.0001), days of antibiotics use (p = 0.025), positive C-reactive protein (p = 0.018) or gastric culture (p = 0.018), and feeding intolerance (p < 0.0001). Total amino acid amount (p < 0.0001), total lipid amount (p < 0.0001), and average daily lipid amount (p = 0.002) were significantly higher in the cholestasis group than in the noncholestasis group. Conversely, prenatal administration of dexamethasone was a significant protective factor of PNAC (p = 0.008). Logistic regression analysis revealed that the cumulative amount of lipid infusion was an independent risk factor for PNAC (p = 0.041; OR 1.174; CI 1.007–1.369). We suggest that decreasing the cumulative load of amino acids and intralipids with early trophic feeding, control of infection, and prenatal administration of dexamethasone could possibly attenuate the severity of PNAC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Aynsley-Green A (1983) Plasma hormone concentrations during enteral and parenteral nutrition in the human newborn. J Pediatr Gastroenterol Nutr 2(Suppl):108–112

    Article  CAS  Google Scholar 

  2. Baird LL (2001) Protecting TPN and lipid infusions from light: reducing hydroperoxides in NICU patients. Neonatal Netw 20:17–22

    PubMed  Google Scholar 

  3. Beath SV, Davies P, Papadopoulou A, Khan AR, Buick RG, Corkery JJ, Gornall P, Booth IW (1996) Parenteral nutrition-related cholestasis in postsurgical neonates: multivariate analysis of risk factors. J Pediatr Surg 31:604–606

    Article  PubMed  CAS  Google Scholar 

  4. Bindl L, Lutjohann D, Buderus S, Lentze MJ, von Bergmann K (2000) High plasma levels of phytosterols in patients on parenteral nutrition: a marker of liver dysfunction. J Pediatr Gastroenterol Nutr 31:313–316

    Article  PubMed  CAS  Google Scholar 

  5. Btaiche IF, Khalidi N (2002) Parenteral nutrition-associated liver complications in children. Pharmacotherapy 22:188–211

    Article  PubMed  Google Scholar 

  6. Bucuvalas JC, Goodrich AL, Blitzer BL, Suchy FJ (1985) Amino acids are potent inhibitors of bile acid uptake by liver plasma membrane vesicles isolated from suckling rats. Pediatr Res 19:1298–1304

    Article  PubMed  CAS  Google Scholar 

  7. Cavicchi M, Beau P, Crenn P, Degott C, Messing B (2000) Prevalence of liver disease and contributing factors in patients receiving home parenteral nutrition for permanent intestinal failure. Ann Intern Med 132:525–532

    PubMed  CAS  Google Scholar 

  8. Colomb V, Jobert-Giraud A, Lacaille F, Goulet O, Fournet JC, Ricour C (2000) Role of lipid emulsions in cholestasis associated with long-term parenteral nutrition in children. J Parenter Enteral Nutr 24:345–350

    CAS  Google Scholar 

  9. Forchielli ML, Gura KM, Sandler R, Lo C (1995) Aminosyn PF or trophamine: which provides more protection from cholestasis associated with total parenteral nutrition? J Pediatr Gastroenterol Nutr 21:374–382

    Article  PubMed  CAS  Google Scholar 

  10. Goulet O, Girot R, Maier-Redelsperger M, Bougle D, Virelizier JL, Ricour C (1986) Hematologic disorders following prolonged use of intravenous fat emulsions in children. J Parenter Enteral Nutr 10:284–288

    CAS  Google Scholar 

  11. Haynes MJ, Stahlman MT, Bradley YB, Jacqueline CJ (2002) Hepatic pathology in extremely low birth weight baboons receiving long term intralipid. Pediatr Res 51:287A

    Google Scholar 

  12. Jacquemin E, Maurage C, Borderon JC, Gold F, Laugier J, Rolland JC (1995) Early cholestasis in premature infants receiving total parenteral nutrition: a possible consequence of shock and hypoxia. Eur J Pediatr Surg 5:259–261

    PubMed  CAS  Google Scholar 

  13. Kelly DA (2006) Intestinal failure-associated liver disease: what do we know today? Gastroenterology 130 (2 Suppl 1):S70–S77

    Article  PubMed  CAS  Google Scholar 

  14. Koletzko B, Goulet O, Hunt J, Krohn K, Shamir R (2005) Guidelines on paediatric parenteral nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr 41(Suppl 2):S1–S87

    PubMed  Google Scholar 

  15. La Scala GC, Le Coultre C, Roche BG, Bugmann P, Belli DC (1993) The addition of lipids increases the TPN-associated cholestasis in the rat. Eur J Pediatr Surg 3:224–227

    Article  PubMed  Google Scholar 

  16. Lima L, Obregon F, Cubillos S, Fazzino F, Jaimes I (2001) Taurine as a micronutrient in development and regeneration of the central nervous system. Nutr Neurosci 4:439–443

    PubMed  CAS  Google Scholar 

  17. Militante JD, Lombardini JB (2002) Taurine: evidence of physiological function in the retina. Nutr Neurosci 5:75–90

    Article  PubMed  CAS  Google Scholar 

  18. Ogle CK, Zuo L, Mao JX, Alexander JW, Fischer JE, Nussbaum MS (1995) Differential expression of intestinal and splenic cytokines after parenteral nutrition. Arch Surg 130:1307–1308

    Google Scholar 

  19. Owings E, Georgeson K (2000) Management of cholestasis in infants with very low birth weight. Semin Pediatr Surg 9:96–102

    PubMed  CAS  Google Scholar 

  20. Sondheimer JM, Asturias E, Cadnapaphornchai M (1998) Infection and cholestasis in neonates with intestinal resection and long-term parenteral nutrition. J Pediatr Gastroenterol Nutr 27:131–137

    Article  PubMed  CAS  Google Scholar 

  21. Spear ML, Spear M, Cohen AR, Pereira GR (1990) Effect of fat infusions on platelet concentration in premature infants. J Parenter Enteral Nutr 14:165–168

    CAS  Google Scholar 

  22. Spencer AU, Yu S, Tracy TF, Aouthmany MM, Llanos A, Brown MB, Brown M, Shulman RJ, Hirschl RB, Derusso PA, Cox J, Dahlgren J, Strouse PJ, Groner JI, Teitelbaum DH (2005) Parenteral nutrition-associated cholestasis in neonates: multivariate analysis of the potential protective effect of taurine. J Parenter Enteral Nutr 29:337–343

    Article  CAS  Google Scholar 

  23. Suchy FJ, Bucuvalas JC, Goodrich AL, Moyer MS, Blitzer BL (1986) Taurocholate transport and Na-K ATPase activity in fetal and neonatal rat liver plasma membrane vesicles. Am J Physiol 251:G665–G673

    PubMed  CAS  Google Scholar 

  24. Thureen PJ, Hay WW Jr (2001) Early aggressive nutrition in preterm infants. Semin Neonatol 6:403–415

    Article  PubMed  CAS  Google Scholar 

  25. Vileisis RA, Inwood RJ, Hunt CE (1980) Prospective controlled study of parenteral nutrition-associated cholestatic jaundice: effect of protein intake. J Pediatr 96:893–897

    Article  PubMed  CAS  Google Scholar 

  26. Walsh MC, Kliegman RM (1986) Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 33:179–201

    PubMed  CAS  Google Scholar 

  27. Watkins JB, Szczepanik P, Gould JB, Klein P, Lester R (1975) Bile salt metabolism in the human premature infant. Preliminary observations of pool size and synthesis rate following prenatal administration of dexamethasone and phenobarbital. Gastroenterology 69:706–713

    PubMed  CAS  Google Scholar 

  28. Wright K, Ernst KD, Gaylord MS, Dawson JP, Burnette TM (2003) Increased incidence of parenteral nutrition-associated cholestasis with aminosyn PF compared to trophamine. J Perinatol 23:444–450

    Article  PubMed  CAS  Google Scholar 

  29. Ziegler EE, Thureen PJ, Carlson SJ (2002) Aggressive nutrition of the very low birthweight infant. Clin Perinatol 29:225–244

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

A part of this study was poster presented in the European Society for Paediatric Research (ESPR) meeting in Bilbao, Spain from 27–30 September 2003.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Yonsei University College of Medicine, Severance Children’s Hospital, 134 Shinchon-Dong, Seodaemun-Ku, C.P.O. Box 8044, 120-752, Seoul, South Korea

    Jae Il Shin, Ran Namgung, Min Soo Park & Chul Lee

Authors
  1. Jae Il Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ran Namgung
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Min Soo Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chul Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ran Namgung.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shin, J.I., Namgung, R., Park, M.S. et al. Could lipid infusion be a risk for parenteral nutrition-associated cholestasis in low birth weight neonates?. Eur J Pediatr 167, 197–202 (2008). https://doi.org/10.1007/s00431-007-0454-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-007-0454-7

Keywords

Search

Navigation