Cholestasis in neonatal intensive care unit: incidence, aetiology and management

Abstract

Infants admitted in NICU have a rate of cholestasis higher than that reported in the general population of live births; in most cases, cholestasis is associated to multiple risk factors and shows a favourable outcome. UDCA does not seem to affect clinical course of cholestasis in this setting.

Ursodeoxycholic acid in neonatal sepsis-associated cholestasis

“…19 However, Tufano et al reported no improvement in ALT, AST, and GGT levels with administration of UDCA (30 mg/kg/day). 13 Varying study results and the lack of statistically significance in our study may explained by the smaller than required sample size and the length of UDCA administration. Tufano et al reported that there were no changes in AST, ALT, and GGT values after 10.5 days of UDCA treatment.…”

“…Tufano et al reported that there were no changes in AST, ALT, and GGT values after 10.5 days of UDCA treatment. 13 However, Hathol et al reported significantly decreased TB and DB levels after 2 weeks, and decreased AST level after 3 weeks of treatment. 19 Oswari et al reported that improvement and resolution of cholestasis occurred on the 19 th day after the onset of sepsis.…”

“…3 Tufano et al found that its prevalence in Naples, Italy in 2009 was 20%. 13 The varying results may be due to differences in study design and the multifactorial nature of SAC pathogenesis. 14 Almost three out of four neonates with SAC had body weight under 2,500 grams, which may be associated with premature birth, similar to a previous report.…”

“…14 In the early stages, ALT and AST levels may be as high as 3-6 times the normal values. 13 Aspartate amino transferase (AST) is also produced by other cells, therefore, in sepsis with multiorgan failure, AST level will be elevated higher than ALT level. 4,7 In our study, the initial liver function levels were found to be higher in the placebo group, which may have affected the outcomes.…”

“…This hypothesis was supported by the findings of Tufano et al who reported that elevated bilirubin (12.23 ± 3.76 mg/dL) was an independent predictor of mortality. 13 The other liver function parameters such as ALT and AST indicate hepatocyte damage. Both ALT and AST levels rise during sepsis, but AST and ALT levels in sepsis accompanied by cholestasis are generally higher than in sepsis without cholestasis.…”