Parenteral nutrition and neonatal cholestasis

Manginello, Frank P.; Javitt, Norman B.

doi:10.1016/s0022-3476(79)80849-5

Cited by 60 publications

(23 citation statements)

References 8 publications

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“…Abbreviations ALT, alanine aminotransferase ANIT, a-naphthylisothiocyanate AST, aspartate aminotransferase CCA, conjugates of cholic acid CG, cholylglycine TPN, total parenteral nutrition In 197 1, Peden and coworkers (3 1) reported the occurrence of cholestasis in a premature infant receiving parenteral nutrition. More than 20 subsequent reports have confirmed this observation (2) and have suggested lack ofenteral alimentation (4), sepsis (24). and immature hepatic excretory function (35) as possible etiologies.…”

Section: Discussionmentioning

confidence: 78%

Cholestatic Effect of Intraperitoneal Administration of Tryptophan to Suckling Rat Pups

et al. 1984

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SummaryThe potential cholestatic effect of amino acids and metabolites of tryptophan were evaluated by use of seven daily intraperitoneal injections to suckling and weanling rat pups. Of the amino acids present in parenteral nutrition solutions, only tryptophan (given at a dose of 4 mM/kg) produced a significant ( p < 0.01) elevation of serum cholylglycine (12.8 2 1.0 pM/liter) as determined by radioimmunoassay, compared to 4.9 f 0.4 pM/liter in salinetreated control animals. Total serum conjugates of cholic acid, as determined by radioimmunoassay, were similarly elevated, as was serum alanine aminotransferase. Tryptophan injection resulted in elevated cholylglycine concentrations only at doses of 3 mM/kg/day or higher. Animals more than 2 weeks old did not demonstrate elevation of serum cholylglycine. Injection of lightexposed tryptophan in suckling animals caused a greater elevation of cholylglycine (39.0 f 8.6 pM/liter) than freshly prepared tryptophan solutions ( p < 0.005). Tryptophan and its spontaneous degradation products could contribute to the cholestatic liver changes observed during parenteral nutrition therapy. Abbreviations ALT, alanine aminotransferase ANIT, a-naphthylisothiocyanate AST, aspartate aminotransferase CCA, conjugates of cholic acid CG, cholylglycine TPN, total parenteral nutrition In 197 1, Peden and coworkers (3 1) reported the occurrence of cholestasis in a premature infant receiving parenteral nutrition. More than 20 subsequent reports have confirmed this observation (2) and have suggested lack ofenteral alimentation (4), sepsis (24). and immature hepatic excretory function (35) as possible etiologies. The incidence of cholestasis is related to the duration of parenteral nutrition (I). The rapidity of onset and the severity has been related to the dose of amino acids administered (36). Such observations suggest that amino acids contained in the solutions may be hepatotoxic.Experimental models utilizing perfused rat liver (15,(32)(33)(34), and isolated rat hepatocytes (7) have demonstrated significant cholestatic effects with both individual amino acids and clinically available amino acid solutions. The present investigation was

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Section: Discussionmentioning

confidence: 78%

Cholestatic Effect of Intraperitoneal Administration of Tryptophan to Suckling Rat Pups

et al. 1984

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“…study so it was not possible to assess this effect. None-addition, it has been suggested that the elevated serum theless, the two premature infants who had not been bile salt concentrations in premature infants could be fed orally before sample collection had raised con-the result of shunting via the ductus venosus (28). centrations of chenodeoxycholate, but not cholate However, the elevation was also present in term infants…”

Section: Discussionmentioning

confidence: 99%

“…The serum bile salt concentration in blood has been used as a measure of cholestasis in the neonates, potentially caused by prolonged parenteral nutrition and by hepatobiliary disease (11,13,28). Such studies could be profoundly affected by the various facets of the immature enterohepatic circulation of bile salts and could lead to erroneous interpretation of the effect of treatment regimes in these infants.…”

Section: Discussionmentioning

confidence: 99%

Postnatal physiologic hypercholemia in both premature and full-term infants.

Barnes¹,

Berkowitz²,

Hirschowitz³

et al. 1981

J. Clin. Invest.

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A B S T R A C T Previous studies have shown that bile salt concentrations in human blood taken from the placenta at birth ofterm infants are in the range found in adults. A 1251-radioimmunoassay procedure and capillary gas liquid chromatography-mass spectrometry have been used in this investigation to measure serum bile salt concentrations in premature and normal term infants. It was found that the serum bile salt concentration in samples taken at birth in premature infants were also similar to that of adults. In the week after birth the serum bile salt concentration rose four-to sevenfold in each of the infant groups. The increase was independent of gestational age and the "health" of the child. A similar increase was observed in term infants. Thus, hypercholemia is physiologic in newborn infants. In conjunction with other abnormalities of the enterohepatic circulation of bile salts there are profound implications in the newborn for the metabolism and excretion of those endogenous and exogenous substances that are dependent on the secretion of bile salt by the liver. In addition, speculations concerning the role of parenteral nutrition in the induction of cholestasis in premature infants should be made with caution.

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“…Os aminoácidos têm um importante papel tóxico pelo fato de que muitas vias enzimáticas de seu metabolismo ainda são imaturas, levando ao acúmulo de seus metabólitos intermediários 24 . Discute-se o fato de que a nutrição parenteral total geralmente está associada ao jejum prolongado e à dieta enteral mínima em prematuros extremos 25,26 . Entretanto, alguns autores afirmam que a colestase, com a conseqüente alteração do índice litogênico e formação de cálculos, é uma complicação tardia da nutrição parenteral total, principalmente em prematuros [27][28][29][30] .…”

Section: Discussionunclassified

Asymptomatic cholelithiasis in an extreme premature child

Cunha¹,

Barros²

2000

J Pediatr (Rio J)

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Parenteral nutrition and neonatal cholestasis

Cited by 60 publications

References 8 publications

Cholestatic Effect of Intraperitoneal Administration of Tryptophan to Suckling Rat Pups

Cholestatic Effect of Intraperitoneal Administration of Tryptophan to Suckling Rat Pups

Postnatal physiologic hypercholemia in both premature and full-term infants.

Asymptomatic cholelithiasis in an extreme premature child

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