Perinatal factors underlying neonatal cholestasis

Conjugated hyperbilirubinemia in the neonatal intensive care unit

“…Hence, the results may be different from those of outpatient settings (3,21,23,24), and might be insufficient regarding long-term prognosis. In contrast to previous studies (9,11,14) which report preterm predominance, only 35% of patients were premature in this series. This might also have impact on the distribution of the etiology of the CH.…”

“…The first was characterized with cardiovascular failure, which was resulted from variety of disorders including asphyxia, shock and heart defects. Several previous studies have also identified these entities as an important causal factor in hepatic dysfunction (10,(12)(13)(14)(15)(16)(17)(18)25,26). Such dysfunction may be explained by the theory of hepatic cell integrity and bile secretion processes which are impaired by hepatic hypoxia-ischemia (10).…”

“…The severity and persistence of liver injury depend on underlying disorders, and the liver damage is usually reversible by stabilization of circulatory problem (25,26). However, normalization of liver dysfunction may take several months (12,14). Because such early-onset CH is due to non-cholestatic liver diseases, it does not usually warrant invasive investigation.…”

“…However, the etiology of cholestasis in newborns at intensive care settings has a spectrum different from that reported in epidemiological studies (4,6), and is usually on multifactorial basis (7)(8)(9)(10)(11). In this population, common perinatal events such as perinatal hypoxia, parenteral nutrition, sepsis, poor enteral feeding, and cardiovascular collapse can contribute to the development of cholestasis (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), in addition to the structurally and functionally immature biliary tract (1,8). Thus, the diagnosis of neonatal cholestasis in this population is one of the most challenging issues.…”

Increased Incidence of Parenteral Nutrition-Associated Cholestasis with Aminosyn PF Compared to Trophamine

“…3 Many of the proposed risk factors for PNAC have been recently reviewed, 4,5 and include low birth weight, prematurity, duration of PN, lack of enteral intake, sepsis, enzyme deficiencies, genetic causes, quantity or quality of amino-acid intake, excess of nonprotein caloric intake, and trace mineral toxicity. Male gender, 6 perinatal depression or shock, 7 and more recently, phototoxicity of parenteral multivitamin supplements, 8 and toxicity from plant phytosterols 9 have also been implicated as potential risk factors for PNAC. Although several of these risk factors are unavoidable, research is still needed to define the optimal parenteral amino-acid solution for pediatric and neonatal patients, 10 one that would allow normal growth and development, result in normal serum aminoacid levels, and cause a minimum of unwanted side effects, such as cholestasis.…”