Parenteral nutrition-associated cholestasis in neonates: multivariate analysis of the potential protective effect of taurine.
BACKGROUND
Neonates receiving parenteral nutrition (PN) are at risk for PN-associated cholestasis (PNAC); however, no preventive factors for PNAC have been clearly identified. Despite reports suggesting that taurine may prevent PNAC in neonates, such an effect of taurine has not yet been definitively demonstrated. We determined whether taurine supplementation reduces the incidence of PNAC in premature or critically ill neonates.


METHODS
This study was part of a prospective, randomized, multi-institutional trial designed to assess cholecystokinin vs placebo as a potential preventive therapy of PNAC. Taurine supplementation of PN varied between institutions. The presence or absence of taurine in PN was analyzed by multivariate analysis, with a primary outcome measure of serum conjugated bilirubin (CB) as a measure of PNAC.


RESULTS
Taurine reduced PNAC in premature infants (estimated maximum CB [95% confidence interval] 0.50 mg/dL [-0.17 to 1.18] for those receiving taurine, vs 3.45 mg/dL [1.79-5.11] for neonates not receiving taurine, approaching significance, p = .07). Taurine significantly reduced PNAC in infants with necrotizing enterocolitis (NEC; estimated maximum CB 4.04 mg/dL [2.85-5.23], NEC infants receiving taurine, vs 8.29 mg/dL [5.61-10.96], NEC infants not receiving taurine, p < .01). There were too few neonates with surgical anomalies to evaluate the effect of taurine in this group.


CONCLUSIONS
Within specific subgroups of neonatal patients, taurine supplementation does offer a very significant degree of protection against PNAC. Patients with NEC or severe prematurity are most likely to benefit substantially from taurine supplementation.
Spencer
Ariel U
AU
Department of Surgery, University of Michigan, and C.S. Mott Children's Hospital, Ann Arbor, MI 48109, USA.
Yu
Sunkyung
S
Tracy
Thomas F
TF
Aouthmany
Moustafa M
MM
Llanos
Adolfo
A
Brown
Morton B
MB
Brown
Marilyn
M
Shulman
Robert J
RJ
Hirschl
Ronald B
RB
Derusso
Patricia A
PA
Cox
Jean
J
Dahlgren
Jacqueline
J
Strouse
Peter J
PJ
Groner
Jonathan I
JI
Teitelbaum
Daniel H
DH
D001663:Bilirubin / Q000097:blood; D002756:Cholagogues and Choleretics / Q000378:metabolism / Q000494:pharmacology; D002766:Cholecystokinin / Q000378:metabolism / Q000494:pharmacology; D002779:Cholestasis / Q000209:etiology / Q000517:prevention & control*; D016638:Critical Illness; D004311:Double-Blind Method; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000209:etiology / Q000517:prevention & control*; D015999:Multivariate Analysis; D010288:Parenteral Nutrition / Q000009:adverse effects*; D011446:Prospective Studies; D013654:Taurine / Q000502:physiology / Q000627:therapeutic use*
D002756:Cholagogues and Choleretics; D013654:Taurine; D002766:Cholecystokinin; D001663:Bilirubin