title: Parenteral nutrition-associated cholestasis in neonates: multivariate analysis of the potential protective effect of taurine.
abstract: 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.
authors.affiliation: Department of Surgery, University of Michigan, and C.S. Mott Children's Hospital, Ann Arbor, MI 48109, USA.
authors.forename: Ariel U
authors.initials: AU
authors.lastname: Spencer
authors.forename: Sunkyung
authors.initials: S
authors.lastname: Yu
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Tracy
authors.forename: Moustafa M
authors.initials: MM
authors.lastname: Aouthmany
authors.forename: Adolfo
authors.initials: A
authors.lastname: Llanos
authors.forename: Morton B
authors.initials: MB
authors.lastname: Brown
authors.forename: Marilyn
authors.initials: M
authors.lastname: Brown
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Shulman
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Hirschl
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Derusso
authors.forename: Jean
authors.initials: J
authors.lastname: Cox
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Dahlgren
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Strouse
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Groner
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Teitelbaum
mesh_terms: 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*
chemical_list: D002756:Cholagogues and Choleretics; D013654:Taurine; D002766:Cholecystokinin; D001663:Bilirubin