A controlled trial of erythromycin and UDCA in premature infants during parenteral nutrition in minimizing feeding intolerance and liver function abnormalities

Gökmen, Tülin; Oğuz, Şerife Suna; Bozdağ, Şenol; Erdeve, Ömer; Uraş, Nurdan; Dilmen, Uğur

doi:10.1038/jp.2011.56

Cited by 29 publications

(18 citation statements)

References 24 publications

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“…In a retrospective study of non-surgical very low birth weight infants with cholestasis on long-term PN, UDCA was associated with shortened course of cholestasis and decreased peak serum bilirubin level compared with historical controls 55 . In another trial of very low birth weight infants, UDCA was associated with a lower incidence of GGT elevation than placebo, but interestingly there was no difference in bilirubin and aminotransferase levels 56 . UDCA use is sometimes limited by diarrhea, which could be a concern in children with SBS.…”

Section: Ursodeoxycholic Acidmentioning

confidence: 94%

Prevention and Treatment of Intestinal Failure-Associated Liver Disease in Children

Raphael

Duggan

2013

Semin Liver Dis

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Intestinal failure-associated liver disease (IFALD), a serious complication occurring in infants, children and adults exposed to long-term parenteral nutrition (PN), causes a wide-spectrum of disease, ranging from cholestasis and steatosis to fibrosis and eventually cirrhosis. Known host risk factors for IFALD include low birth weight, prematurity, short bowel syndrome and recurrent sepsis. The literature suggests that components of PN may also play a part of the multifactorial pathophysiology. Because some intravenous lipid emulsions (ILE) may contribute to inflammation and interfere with bile excretion, treatment with ILE minimization and/or ILEs composed primarily of omega-3 fatty acids can be helpful but requires careful monitoring for growth failure and essential fatty acid deficiency (EFAD). Data from randomized controlled trials are awaited to support widespread use of these approaches. Other IFALD treatments include cycling PN, ursodeoxycholic acid, sepsis prevention, photoprotection and polyvinylchloride-free tubing. Management and prevention of IFALD remains a clinical challenge.

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Section: Ursodeoxycholic Acidmentioning

confidence: 94%

Prevention and Treatment of Intestinal Failure-Associated Liver Disease in Children

Raphael

Duggan

2013

Semin Liver Dis

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“…In particular the content of taurine in the amino acid solution (0.3 g/100 ml; Aminopaed 10%; Fresenius Kabi, Graz, Austria, EU) and the nature of lipid emulsion (exclusively soybean oil based; Intralipid 20%, Fresenius Kabi, Graz, Austria, EU) did not change. In both periods, urodeoxycholic acid was used for treatment—but not prevention ( Gokmen et al, 2012 )—of PNAC. Infants did not receive erythromycin ( Aly et al, 2007 ; Gokmen et al, 2012 ; Ng et al, 2007 ) to reduce time until full enteral feeds.…”

Section: Methodsmentioning

confidence: 99%

Aggressive nutrition in extremely low birth weight infants: impact on parenteral nutrition associated cholestasis and growth

Repa

Lochmann

Unterasinger

et al. 2016

PeerJ

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BackgroundParenteral nutrition associated cholestasis (PNAC) is a frequently observed pathology in extremely low birth weight (ELBW) infants. Its pathogenesis is determined by the composition and duration of parenteral nutrition (PN) as well as the tolerance of enteral feeds (EF). “Aggressive” nutrition is increasingly used in ELBW infants to improve postnatal growth. Little is known about the effect of “aggressive” nutrition on the incidence of PNAC. We analyzed the influence of implementing an “aggressive” nutritional regimen on the incidence of PNAC and growth in a cohort of ELBW infants.MethodsELBW infants were nourished using a “conservative” (2005–6; n = 77) or “aggressive” (2007–9; n = 85) nutritional regimen that differed in the composition of PN after birth as well as the composition and timing of advancement of EFs. We analyzed the incidence of PNAC (conjugated bilirubin > 1.5 mg/dl (25 µmol/l)) corrected for confounders of cholestasis (i.e., NEC and/or gastrointestinal surgery, sepsis, birth weight, Z-score of birth weight, time on PN and male sex), growth until discharge (as the most important secondary outcome) and neonatal morbidities.ResultsThe incidence of PNAC was significantly lower during the period of “aggressive” vs. “conservative “nutrition (27% vs. 46%, P < 0.05; adjusted OR 0.275 [0.116–0.651], P < 0.01). Body weight (+411g), head circumference (+1 cm) and length (+1 cm) at discharge were significantly higher. Extra-uterine growth failure (defined as a Z-score difference from birth to discharge lower than −1) was significantly reduced for body weight (85% vs. 35%), head circumference (77% vs. 45%) and length (85% vs. 65%) (P < 0.05). The body mass index (BMI) at discharge was significantly higher (11.1 vs. 12.4) using “aggressive” nutrition and growth became more proportionate with significantly less infants being discharged below the 10th BMI percentile (44% vs. 9%), while the percentage of infants discharged over the 90th BMI percentile (3% vs. 5%) did not significantly increase.Discussion“Aggressive” nutrition of ELBW infants was associated with a significant decrease of PNAC and marked improvement of postnatal growth.

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“…In a recent ESPGHAN position paper [519] early EN is recommended limiting i. v. lipid to 15e30 % of non-protein energy provided by PN and cyclic administration of PN once the patient is stable. The use of ursodeoxycholic acid (UDCA) and erythromycin has been reported to facilitate EN in premature infants on PN [520]. The authors of the ASPEN clinical guidelines analyzed seven publications on this issue and found a very low level of evidence for a beneficial role of UDCA in the treatment of PNAC [488].…”

Section: Commentarymentioning

confidence: 99%

ESPEN guideline on clinical nutrition in liver disease

et al. 2019

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This update of evidence-based guidelines (GL) aims to translate current evidence and expert opinion into recommendations for multidisciplinary teams responsible for the optimal nutritional and metabolic management of adult patients with liver disease. The GL was commissioned and financially supported by ESPEN. Members of the guideline group were selected by ESPEN. We searched for meta-analyses, systematic reviews and single clinical trials based on clinical questions according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing the SIGN method. A total of 85 recommendations were made for the nutritional and metabolic management of patients with acute liver failure, severe alcoholic steatohepatitis, non-alcoholic fatty liver disease, liver cirrhosis, liver surgery and transplantation as well as nutrition associated liver injury distinct from fatty liver disease. The recommendations are preceded by statements covering current knowledge of the underlying pathophysiology and pathobiochemistry as well as pertinent methods for the assessment of nutritional status and body composition.

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A controlled trial of erythromycin and UDCA in premature infants during parenteral nutrition in minimizing feeding intolerance and liver function abnormalities

Cited by 29 publications

References 24 publications

Prevention and Treatment of Intestinal Failure-Associated Liver Disease in Children

Prevention and Treatment of Intestinal Failure-Associated Liver Disease in Children

Aggressive nutrition in extremely low birth weight infants: impact on parenteral nutrition associated cholestasis and growth

ESPEN guideline on clinical nutrition in liver disease

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