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  • Original Article
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Demographic and nutritional factors associated with prolonged cholestatic jaundice in the premature infant

Journal of Perinatology volume 28, pages 129–135 (2008)Cite this article

Abstract

Objective:

The primary aim of this study was to determine if an association exists between amino-acid levels and development of cholestasis. The secondary aim of our amino-acid dose comparison trial was to identify factors associated with the development of prolonged cholestatic jaundice.

Study Design:

We compared demographic characteristics and amino-acid levels in neonates who developed cholestasis with those who did not. Parenteral-associated cholestatic liver disease was defined as a direct serum bilirubin above 5 mg per 100 ml any time during the first 28 days after birth in neonates with no history of biliary atresia or viral hepatitis. We obtained filter paper blood spots for amino acid and acylcarnitine measurements on the day of randomization and days 7 and 28 of age to identify a profile of values that could be used to identify neonates with evidence of abnormal liver function.

Result:

We enrolled 122 neonates in our study; 13 (10.7%) developed cholestasis. Neonates who developed cholestasis were more immature, had lower birth weight, were exposed to parenteral nutrition for a longer period, had a higher cumulative dose of amino acids, were less often on enteral nutrition by day 7 of age, more often had a patent ductus arteriosus and severe intraventricular hemorrhage and were more commonly treated with steroids by 28 days of age. Amino acid and acylcarnitine values were not different for the two groups on the day of randomization. On day 7 (parenteral phase of nutrition), blood urea nitrogen, citrulline, histidine, methionine and succinyl carnitine were higher, and serine, glutamate and thyroxine levels were lower in the neonates who developed cholestasis than in who did not.

Conclusion:

Cholestasis remains an important complication of parenteral nutrition, and several clinical and biochemical factors may be helpful in identifying high-risk patients.

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Author information

Authors and Affiliations

  1. Pediatrix-Obstetrix Center for Research and Education and Pediatrix Analytical, Sunrise, FL, USA

    M Steinbach, R H Clark, A S Kelleher, C Flores, R White, D H Chace & A R Spitzer

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  1. M Steinbach
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  2. R H Clark
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  3. A S Kelleher
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  4. C Flores
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  6. D H Chace
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  7. A R Spitzer
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For the Pediatrix Amino-Acid Study Group

Corresponding author

Correspondence to R H Clark.

Additional information

Pediatrix Amino-Acid Study Group

Principal Investigators: Debra Bender, ARNP—Swedish Medical Center (WA); Barbara Carr, MD—St Luke's Hospital (MO); Carlos Flores, MD—Tucson Medical Center (AZ); Jose Gierbolini, MD—Stormont-Vail Regional Health Center (KS); David W Green, MD—Presbyterian Hospital of Dallas (TX); Joseph Harlan, MD—McLeod Regional Medical Center (SC); Michael Kamitsuka, MD—Swedish Medical Center (WA); Sridhar Kaushik, MD—Pinnacle Health—Harrisburg Hospital (PA); Amy S Kelleher, BS—Pediatrix Medical Group (FL); Jose Perez, MD—Arnold Palmer Medical Center (FL); Meera Sankar, MD—Good Samaritan Medical Center (CA); Bindya Singh, MD—Good Samaritan Medical Center (CA); Margaret Steinbach, NNP—Pediatrix Medical Group (FL); Robert White—Memorial Hospital of South Bend (IN); Henry H Wooldridge, MD—East Tennessee Children's Hospital (TN).

Study Registration Number: ClinicalTrials.gov Identifier: NCT00120926; http://clinicaltrials.gov/ct/show/NCT00120926?order=1.

Contributors: East Tennessee Children's Hospital (TN)—P Kathine Fulton, RNC, NNP; Good Samaritan Medical Center (CA)—Chrissy Weng RN; McLeod Regional Medical Center (SC)—Evelyn Fulmore, Pharm D; Memorial Hospital of South Bend (IN)—Delores Troyer NNP; Pinnacle Health—Harrisburg Hospital (PA)—Penny Barcavage NNP; Presbyterian Hospital of Dallas (TX)—Renuka K Reddy, MD; Stormont-Vail Regional Health Center (KS)—Renee Hunt, RNC, NNP; Tucson Medical Center (AZ)—Colleen Bakewell.

Conflict of interest: All of the authors are employees of Pediatrix Medical Group that owns Pediatrix Screening, a company that offers newborn screening for inborn errors of metabolism and hearing loss.

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Steinbach, M., Clark, R., Kelleher, A. et al. Demographic and nutritional factors associated with prolonged cholestatic jaundice in the premature infant. J Perinatol 28, 129–135 (2008). https://doi.org/10.1038/sj.jp.7211889

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