Early cholestasis in premature infants receiving total parenteral nutrition: a possible consequence of shock and hypoxia.
We report 18 premature infants (gestational age: 31.1 weeks +/- 2.6 [mean +/- SD] (range: 28-36]) with necrotizing enterocolitis (NEC) who developed total parenteral nutrition (TPN) associated cholestasis. Liver function tests were performed at the start of TPN (D1) and repeated once a week. Considering the date of cholestasis onset (direct bilirubin > 30 mumol/l and/or serum bile salts > 10 mumol/l), the patients can be divided in two groups. The first group consisted of 9 patients who had cholestasis at D1. In these patients shock and/or hypoxia occurred prior to D1 and were the only risk factors of cholestasis identified before D1. The second group consisted of 9 patients who developed cholestasis after D1 and in whom the cause of cholestasis was multifactorial (sepsis, lack of enteral feeding, shock and/or hypoxia). These results suggest that shock and/or hypoxia can be responsible for early cholestasis in premature infants. We conclude that shock and hypoxia should be considered when discussing TPN-associated cholestasis.
Jacquemin
E
E
Gastroenterology Unit, Clocheville Children's Hospital, Tours, France.
Maurage
C
C
Borderon
J C
JC
Gold
F
F
Laugier
J
J
Rolland
J C
JC
D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000150:complications*; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000209:etiology*; D008111:Liver Function Tests; D008297:Male; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D011446:Prospective Studies; D012307:Risk Factors; D012769:Shock / Q000150:complications*