Decreased cholestasis with enteral instead of intravenous protein in the very low-birth-weight infant.
Thirty to 50% of very low-birth-weight infants have parenteral nutrition-associated cholestasis. To test the hypothesis that the incidence of cholestasis would be decreased if parenteral amino acids were avoided and protein given enterally, infants with a gestational age of less than 30 weeks were randomized to two groups. One group received amino acid-free parenteral nutrition and whey protein enterally with added premature infant formula. The control group received standard parenteral nutrition with amino acids and enteral premature formula. At the end of 3 weeks of parenteral nutrition, infants who had a direct serum bilirubin level of greater than 3 mg/dl were considered to have significant cholestasis. Twenty-nine infants required parenteral nutrition for 3 weeks, 17 in the whey group and 12 in the control group. No instances of significant cholestasis were observed in the whey group (0/17), whereas seven of 12 infants (58%) in the amino acid control group had cholestasis (p less than 0.001).
Brown
M R
MR
Department of Pediatrics, Strong Memorial Hospital, University of Rochester Medical Center, New York 14642.
Thunberg
B J
BJ
Golub
L
L
Maniscalco
W M
WM
Cox
C
C
Shapiro
D L
DL
D000596:Amino Acids / Q000008:administration & dosage; D002779:Cholestasis / Q000209:etiology / Q000517:prevention & control*; D004750:Enteral Nutrition; D005069:Evaluation Studies as Topic; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight / Q000378:metabolism*; D007231:Infant, Newborn; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D011506:Proteins / Q000008:administration & dosage*
D000596:Amino Acids; D011506:Proteins