Parenteral nutrition-associated cholestasis in preterm neonates: Evaluation of ursodeoxycholic acid treatment
Parenteral nutrition-associated cholestasis in preterm neonates: Evaluation of ursodeoxycholic acid treatment
复制标题
DOI：
10.1515/jpem.1999.12.4.549
复制
发表时间：
1999-07-01
影响因子：
1.4
通讯作者：
Sirotta, L
中科院分区：
文献类型：
--
作者：
Levine, A;Maayan, A;Sirotta, L
背景/目的：肠外营养是早产儿护理的一个组成部分，胆汁淤积性肝病是长期肠外营养的常见并发症，尤其是在早产儿中。有研究表明，熊去氧胆酸可能会改变儿童和成人肠外营养相关胆汁淤积的病程。我们试图确定熊去氧胆酸在早产儿肠外营养相关性胆汁淤积中的疗效。方法：回顾性分析40床新生儿重症监护室接受熊去氧胆酸治疗肠外营养相关性胆汁淤积的所有婴儿的病历。熊去氧胆酸的疗效通过胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶和碱性磷酸酶在至少1个月的治疗期内的反应来评估。结果：确定了6名接受熊去氧胆酸治疗1个月的肠外营养相关胆汁淤积婴儿。熊去氧胆酸的剂量范围为15-30 mg/kg/天，在平均42 +/- 15天的肠外营养后，平均47 +/- 17（平均+/- SD）天出现胆汁淤积，3例婴儿的转氨酶水平降低，其他3例婴儿的转氨酶水平升高或无变化。所有婴儿的胆红素水平均下降。碱性磷酸酶水平呈非显著下降趋势，所有婴儿仅在完全肠内营养10天后才出现一致性改善，熊去氧胆酸治疗期间未发现毒性。熊去氧胆酸治疗早产儿似乎是安全的，并导致胆红素水平在治疗两周后早期持续下降，在我们的小队列中，转氨酶水平的反应没有持续。
Background/Objective: Parenteral nutrition is an integral part of the care of premature infants, Cholestatic liver disease is a frequent complication of prolonged parenteral nutrition, especially in premature infants. It has been suggested that ursodeoxycholic acid may alter the course of parenteral nutrition-associated cholestasis in children and adults. We attempted to determine the efficacy of ursodeoxycholic acid in premature infants with parenteral nutrition-associated cholestasis,Methods: Retrospective chart review of all infants receiving ursodeoxycholic acid for parenteral nutrition-associated cholestasis in a 40 bed neonatal intensive care unit. Efficacy of ursodeoxycholic acid was evaluated by response of bilirubin, alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase over a treatment period of at least 1 month,Results: Six infants with parenteral nutrition-associated cholestasis who had received ursodeoxycholic acid for one month were identified. Doses of ursodeoxycholic acid ranged from 15-30 mg/kg/day, Cholestasis appeared at a mean age of 47 +/- 17 (mean +/- SD) days after a mean of 42 +/- 15 days of parenteral nutrition, Transaminase levels decreased in three, and either increased or did not change in the other three infants. Bilirubin levels decreased in all infants. Alkaline phosphatase showed a non significant trend to decreased levels, Consistent improvement in all infants was noted only after 10 days of full enteral nutrition, No toxicity was found during ursodeoxycholic acid treatment.Conclusions: Ursodeoxycholic acid treatment in premature infants appears to be safe, and leads to an early sustained decrease in bilirubin levels by two weeks of therapy, The response of transaminase levels was not sustained in our small cohort.