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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

 Soon Min Lee  ;  Ran Namgung  ;  Min Soo Park  ;  Ho Sun Eun  ;  Nam Hyo Kim  ;  Kook In Park  ;  Chul Lee 
 YONSEI MEDICAL JOURNAL, Vol.54(4) : 839-844, 2013 
Journal Title
Issue Date
Bilirubin/blood ; Case-Control Studies ; Cholestasis/diagnosis ; Cholestasis/epidemiology ; Cholestasis/etiology* ; Comorbidity ; Female ; Humans ; Infant, Newborn ; Infant, Premature, Diseases/epidemiology ; Infant, Premature, Diseases/etiology ; Infant, Small for Gestational Age* ; Infant, Very Low Birth Weight ; Liver/metabolism ; Liver/physiopathology ; Male ; Parenteral Nutrition/adverse effects*
Parenteral nutrition associated cholestasis ; appropriate for gestational age ; hepatic dysfunction ; small for gestational age
PURPOSE: 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. MATERIALS AND 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. CONCLUSION: The clinical course of PNAC is more persistent and severe in SGA infants. Careful monitoring and treatment are required for SGA infants.
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1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Nam Hyo(김남효)
Namgung, Ran(남궁란) ORCID logo https://orcid.org/0000-0001-7182-9535
Park, Kook In(박국인) ORCID logo https://orcid.org/0000-0001-8499-9293
Park, Min Soo(박민수) ORCID logo https://orcid.org/0000-0002-4395-9938
Eun, Ho Seon(은호선) ORCID logo https://orcid.org/0000-0001-7212-0341
Lee, Soon Min(이순민) ORCID logo https://orcid.org/0000-0003-0174-1065
Lee, Chul(이철)
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