Abstract
Background: Parenteral nutrition-associated cholestasis (PNAC) is frequently seen in preterm infants receiving total parenteral nutrition (TPN) for a long duration. The pathogenesis of PNAC is believed to be multifactorial; however, phytosterols are hepatotoxic, resulting in cholestasis. A novel lipid emulsion consisting of a mixture of soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOFlipid) with a low level of phytosterols has been shown to improve cholestasis. Moreover, ursodeoxycholic acid (UDCA) has improved bile flow and normalized liver function tests. This study aimed to determine the effect of UDCA and SMOFlipid in preventing and treating PNAC in infants.Methods: We conducted a retrospective cohort study that included all infants who received TPN for at least five days between January 2010 and December 2018, who also received UDCA for the treatment of cholestasis, and infants who developed cholestasis but were not treated with UDCA. In addition, any infants who received SMOFlipid for parenteral nutrition during the same period were included. We recorded multiple variables, including neonatal demographic data, major medical diagnosis, liver function, medications, and maternal variables.Results: A total of 58 infants with cholestasis who received UDCA for treatment were identified. The infants were divided into two groups, Group 1 infants had gestational age (GA) of ≤32 weeks, and Group 2 had GA of >32 weeks. We found that combining SMOFlipid with UDCA resulted in a significant reduction in cholestasis duration in both groups. Infants in Group 1 who received SMOFlipid had cholestasis for a mean of 67 ± 57 days, and those who did not receive SMOFlipid had cholestasis for a mean of 145 ± 102 days (p=0.04). Infants in Group 2 who received SMOFlipid had cholestasis for a mean of 38.2 ± 28 days, and those who did not receive SMOFlipid had cholestasis for a mean of 117 ± 119 days (p=0.02).Conclusions: According to our results, the use of UDCA and SMOFlipid reduced the duration of parenteral nutrition-associated with cholestasis in very low birth weight infants.
Highlights
Parenteral nutrition-associated cholestasis (PNAC) is often seen in preterm infants receiving prolonged total parenteral nutrition (TPN)
We found that combining SMOFlipid with ursodeoxycholic acid (UDCA) resulted in a significant reduction in cholestasis duration in both groups
According to our results, the use of UDCA and SMOFlipid reduced the duration of parenteral nutrition-associated with cholestasis in very low birth weight infants
Summary
Parenteral nutrition-associated cholestasis (PNAC) is often seen in preterm infants receiving prolonged total parenteral nutrition (TPN). Hepatic cholestasis usually results from an impaired balance between bile acid uptake and efflux This impairment leads to abnormal hepatic accumulation of bile salts that disrupt cell membranes and cellular organelles, hepatic cell necrosis, inflammation, and fibrosis occur [1]. In clinical practice, it is characterized by direct jaundice and/or increased levels of hepatic biomarkers such as gamma-glutamyl transpeptidase (GGT) and/or alkaline phosphatase (ALP) [2]. Parenteral nutrition-associated cholestasis (PNAC) is frequently seen in preterm infants receiving total parenteral nutrition (TPN) for a long duration. This study aimed to determine the effect of UDCA and SMOFlipid in preventing and treating PNAC in infants
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