title: Copper supplementation in parenteral nutrition of cholestatic infants.
abstract: OBJECTIVE
  Conventional practice is to reduce or eliminate copper (Cu) supplementation in the parenteral nutrition of infants with cholestasis because of the increased risk of hepatotoxicity. However, there are reports of Cu deficiency in cholestatic infants because of Cu reduction in their parenteral nutrition. The objectives of the present study are to determine the proportion of cholestatic infants who develop elevated serum Cu while receiving a nonreduced dose of parenteral Cu, to evaluate potential clinical factors that affect serum Cu in cholestatic infants, and to evaluate the impact of serum Cu on liver disease.
  
  
  METHODS
  This is a retrospective review of 28 cholestatic infants receiving 20 microg x kg(-1) x day(-1) of Cu via parenteral nutrition. Age-adjusted references were used to determine normality of serum Cu levels. Multiple linear regression analyses were performed to determine predictors of serum Cu and alanine aminotransferase (ALT).
  
  
  RESULTS
  Serum Cu levels were elevated in 2 infants (7%). On average, infants received 80% of their energy intake from parenteral nutrition for 3 months. Intestinal failure was present in 50% of the patients. Birth weight, gestational age, and ALT were identified as predictors of serum Cu (R2 = 0.53; P = 0.0001). Serum Cu, gestational age, and total bilirubin were associated with serum ALT (R2 = 0.43; P = 0.001).
  
  
  CONCLUSIONS
  Supplementation of parenteral Cu at 20 microg x kg(-1) x day(-1) does not lead to a significant increase in Cu toxicity or worsening of liver disease in cholestatic infants.
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA. fremjulianac@uams.edu
authors.forename: Juliana
authors.initials: J
authors.lastname: Frem
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Sarson
authors.forename: Tom
authors.initials: T
authors.lastname: Sternberg
authors.forename: Conrad R
authors.initials: CR
authors.lastname: Cole
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D001724:Birth Weight; D002779:Cholestasis / Q000097:blood*; D003300:Copper / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D019587:Dietary Supplements; D002149:Energy Intake; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases; D008107:Liver Diseases / Q000097:blood*; D010288:Parenteral Nutrition / Q000379:methods*; D012044:Regression Analysis; D012189:Retrospective Studies
chemical_list: D003300:Copper; D000410:Alanine Transaminase; D001663:Bilirubin
references.citation: Coll Antropol. 2006 Sep;30(3):523-8
references.pmid: 17058518
references.citation: Biol Neonate. 1983;44(2):108-13
references.pmid: 6882845
references.citation: Pediatrics. 2004 Nov;114(5):1362-4
references.pmid: 15520122
references.citation: Nutr Clin Pract. 2004 Jun;19(3):305-8
references.pmid: 16215119
references.citation: Gastroenterology. 1981 Aug;81(2):290-7
references.pmid: 6786953
references.citation: J Pediatr. 1983 Sep;103(3):441-6
references.pmid: 6411885
references.citation: Am J Clin Nutr. 1988 Nov;48(5):1324-42
references.pmid: 3142247
references.citation: J Pediatr Gastroenterol Nutr. 2003 Oct;37(4):422-9
references.pmid: 14508211
references.citation: J Pediatr Surg. 2004 May;39(5):690-5
references.pmid: 15137001
references.citation: J Clin Gastroenterol. 2005 Apr;39(4):318-20
references.pmid: 15758626
references.citation: Gastroenterology. 2006 Feb;130(2 Suppl 1):S16-28
references.pmid: 16473066
references.citation: Am J Clin Nutr. 1998 May;67(5 Suppl):952S-959S
references.pmid: 9587135
references.citation: Clin Perinatol. 2000 Mar;27(1):119-29, vi
references.pmid: 10690567
references.citation: Am J Clin Nutr. 2008 Sep;88(3):859S-62S
references.pmid: 18779309