title: Parenteral nutrition associated cholestasis is earlier, more prolonged and severe in small for gestational age compared with appropriate for gestational age very low birth weight infants.
abstract: OBJECTIVE
  We hypothesized that parenteral nutrition associated cholestasis (PNAC) would be more severe in small for gestational age (SGA) compared with appropriate for gestational age (AGA) very low birth weight (VLBW) infants.
  
  
  METHODS
  Sixty-one VLBW infants were diagnosed as PNAC with exposure to parenteral nutrition with elevation of direct bilirubin≥2 mg/dL for ≥14 days. Twenty-one SGA infants and 40 AGA infants matched for gestation were compared.
  
  
  RESULTS
  Compared with AGA infants, PNAC in SGA infants was diagnosed earlier (25±7 days vs. 35±14 days, p=0.002) and persisted longer (62±36 days vs. 46±27 days, p=0.048). Severe PNAC, defined as persistent elevation of direct bilirubin≥4 mg/dL for more than 1 month with elevation of liver enzymes, was more frequent in SGA than in AGA infants (61% vs. 35%, p=0.018). The serum total bilirubin and direct bilirubin levels during the 13 weeks of life were significantly different in SGA compared with AGA infants. SGA infants had more frequent (76% vs. 50%, p=0.046), and persistent elevation of alanine aminotransferase.
  
  
  CONCLUSIONS
  The clinical course of PNAC is more persistent and severe in SGA infants. Careful monitoring and treatment are required for SGA infants.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
authors.forename: Soon Min
authors.initials: SM
authors.lastname: Lee
authors.forename: Ran
authors.initials: R
authors.lastname: Namgung
authors.forename: Min Soo
authors.initials: MS
authors.lastname: Park
authors.forename: Ho Sun
authors.initials: HS
authors.lastname: Eun
authors.forename: Nam Hyo
authors.initials: NH
authors.lastname: Kim
authors.forename: Kook In
authors.initials: KI
authors.lastname: Park
authors.forename: Chul
authors.initials: C
authors.lastname: Lee
mesh_terms: D001663:Bilirubin / Q000097:blood; D016022:Case-Control Studies; D002779:Cholestasis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000209:etiology; D007236:Infant, Small for Gestational Age; D019102:Infant, Very Low Birth Weight; D008099:Liver / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects*
chemical_list: D001663:Bilirubin
keywords: Parenteral nutrition associated cholestasis; appropriate for gestational age; hepatic dysfunction; small for gestational age