PEDIATRICS Vol. 62 No. 6 December 1978, pp. 984-989
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Cholestatic Tendencies in Premature Infants on and off Parenteral Nutrition

Judith M. Sondheimer M.D.1, Heather Bryan M.D.1, Wayne Andrews M.D.1, and Gordon G. Forstner M.D.1

1 Hospital for Sick Children, Toronto

We measured the levels of serum conjugates of cholic acid (SCCA) by radioimniunoassay in 32 newborn infants during the course of intravenous (IV) alimnentation (study group 1, birth weight > 2 kg; study group 2, birth weight <2 kg) and compared them to those of two groups of weight-matched control subjects and one group of normal infants and adults. Fasting SCCA levels in the two newborn control groups were significantly higher than those of normal infants and adults, and a significant postprandial elevation in SCCA level was present in the smaller of the two newborn control groups. During the first two weeks of alimentation only one patient had an elevated SCCA level (< 2 SD above that of control subjects), without other abnormalities of liver function. In study group 1 patients who received alimentation for more than two weeks, significant increases in mean peak SCCA level occurred and seven of eight patients had elevated levels. Three patients became jaundiced and had high alkaline phosphate values. Group 2 patients who received alimentation for more than two weeks were unaffected. Therefore, the appearance of liver abnormalities was related to body mass and duration of IV alimentation. The presence of documented or suspected sepsis, withholding of oral feedings, or the use of Intralipid could not be specifically related to SCCA levels. These results indicate that the small premature infant has a limited hepatic excretory function and suggest that excretory immaturity is an important factor in the susceptibility of these infants to cholestasis associated with long-term IV alimentation.

Submitted on October 31, 1977
Accepted on May 4, 1978




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