Use of Cholecystokinin-Octapeptide for the Prevention of Parenteral Nutrition-Associated Cholestasis

Teitelbaum, Daniel H.; Tracy, Thomas F.; Aouthmany, Moustafa M.; Llanos, Adolfo; Brown, Morton B.; Yu, Sunkyung; Brown, Marilyn R.; Shulman, Robert J.; Hirschl, Ronald B.; DeRusso, Patricia A.; Cox, Jeanne; Dahlgren, Jacqueline; Groner, Judith A.; Strouse, Peter J.

doi:10.1542/peds.2004-1014

Cited by 68 publications

(31 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, to date, studies testing prophylactic strategies have not identified a consistently successful method, other than discontinuing the PN, which frequently is not a feasible option. Those studies included prophylactic administration of taurosusodeoxycholic acid, 5 cholecystokinin-octapeptide, 6,7 taurine, 8 phenobarbitol 9 and removing copper and manganese from the PN. 10,11 One problem inherent in any prophylactic strategy in the NICU is accurately predicting which neonates are at highest risk for developing the adverse outcome, so that high-risk patients can be eligible for study while low-risk patients can be excluded.…”

Section: Introductionmentioning

confidence: 99%

Identifying patients, on the first day of life, at high-risk of developing parenteral nutrition-associated liver disease

et al. 2007

View full text Add to dashboard Cite

Section: Introductionmentioning

confidence: 99%

Identifying patients, on the first day of life, at high-risk of developing parenteral nutrition-associated liver disease

et al. 2007

View full text Add to dashboard Cite

“…Cholecystokinin is a gastrointestinal hormone that has been shown to promote choleresis [17,18] , and was suggested in a retrospective cohort study to prevent severe conjugated hyperbilirubinemia (defined as direct bilirubin 6 5.0 mg/dl) [19] . However, a recent large multicenter double-blind, randomized, controlled trial of cholecystokinin-octapeptide in neonates did not show any effect on conjugated bilirubin levels, incidence of biliary sludge or cholelithiasis formation [15] . Cholecystectomy is used commonly in adults but not in neonates.…”

Section: Discussionmentioning

confidence: 88%

“…In addition to saline, lavage with the mucolytic agent N-acetylcysteine [13] has been described. Other modalities have been described, including enterallyadministered ursodeoxycholic acid [14] , parenterally-administered cholecystokinin [15] , and cholecystectomy [5] .…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Percutaneous Cholecystostomy for Acute Neonatal Biliary Obstruction

Helin

Bhat²,

Рао³

2006

Neonatology

View full text Add to dashboard Cite

Use of a percutaneously-inserted cholecystostomy drainage tube is an effective therapeutic option for acute hyperbilirubinemia in severely-ill adult patients, but to our knowledge has not been previously reported in infants. We describe an infant who developed acute extrahepatic biliary tract obstruction with marked conjugated (direct) hyperbilirubinemia, and who was determined to be an unsuitable surgical candidate. Ultrasound-guided percutaneous cholecystostomy was performed and resulted in prompt, significant, and sustained decline in serum bilirubin levels. Potential risks and benefits, as well as suggested indications for the procedure are discussed.

show abstract

“…As early as 3-4 days after the start of TPN, gallbladder distension and formation of sludge have been diagnosed in term and preterm neonates [1,2,9] . Concerns regarding parenteral nutrition-associated cholestasis resulted in considerable efforts for their prevention [10] . These failed to prove efficacious.…”

Section: Discussionmentioning

confidence: 99%

Prospective Volumetric Analysis of Gallbladders in Critically Ill Newborns: The Impact of Nutrition

et al. 2007

View full text Add to dashboard Cite

Background:Neonatal reference values of gallbladder size have been assessed in healthy newborns with enteral feeding regimen. Their applicability to critically ill patients under total parenteral nutrition (TPN) remains to be questioned. Objective: Our aim was to evaluate the impact of short-term TPN versus enteral nutrition (EN), gender and birth weight on neonatal gallbladder volume. Method: A prospective pilot study was initiated with a single sonographic investigator blinded towards feeding regimen. In total, 61 neonates (33 males, 28 females) were consecutively enrolled on the intensive care unit; 31 newborns were examined both under TPN and bolus EN (breast milk/formula). Patients with malformations of the biliary tract were excluded. Prior to ultrasound examinations, a minimum fasting period of 2 h was maintained. Sonographic measurements of gallbladder length, depth and width were performed to calculate gallbladder volume using the ellipsoid formula. Results: Neonatal gallbladder volume differed significantly between TPN and EN (p < 0.001). Using TPN, range of gallbladder length, width and volume exceeded reference values. Birth weight was weakly correlated with gallbladder volume (correlation index 0.3776, p = 0.01). We found no gender-related differences. Conclusions: Neonatal gallbladder volume under TPN was significantly larger compared to EN. Using TPN, gallbladder dimensions exceeded reference values without causing clinical complications. The benign course of gallbladder enlargement required no specific medication or surgical treatment.

show abstract

Use of Cholecystokinin-Octapeptide for the Prevention of Parenteral Nutrition-Associated Cholestasis

Abstract: Use of CCK-OP failed to reduce significantly the incidence of PNAC or levels of CB. CCK-OP had no effect on other secondary measures and should not be recommended for the prevention of PNAC.

Cited by 68 publications

References 40 publications

Identifying patients, on the first day of life, at high-risk of developing parenteral nutrition-associated liver disease

Identifying patients, on the first day of life, at high-risk of developing parenteral nutrition-associated liver disease

Ultrasound-Guided Percutaneous Cholecystostomy for Acute Neonatal Biliary Obstruction

Prospective Volumetric Analysis of Gallbladders in Critically Ill Newborns: The Impact of Nutrition

Contact Info

Product

Resources

About