doiSerbia

Preventive effect of ursodeoxycholic acid on parenteral nutrition-associated liver disease in infants

Simić Dušica (University Children’s Hospital, Belgrade + Faculty of Medicine, Belgrade)
Milojević Irina (University Children’s Hospital, Belgrade)
Bogićević Dragana (University Children’s Hospital, Belgrade + Faculty of Medicine, Belgrade)
Milenović Miodrag (Center for Anesthesiology and Resuscitation, Emergency Center, Clinical Center of Serbia, Belgrade)
Radlović Vladimir (University Children’s Hospital, Belgrade)
Drašković Biljana (Clinic of Pediatric Surgery, Institute for Child and Youth Health Care, Novi Sad + Faculty of Medicine, Novi Sad)
Uram-Benka Anna (Clinic of Pediatric Surgery, Institute for Child and Youth Health Care, Novi Sad + Faculty of Medicine, Novi Sad)
Sinđić Sanja (University Children’s Hospital, Belgrade + Faculty of Medicine, Belgrade)
Maksimović Ružica (Faculty of Medicine, Belgrade + Center for MRI, Clinical Center of Serbia, Belgrade)

Introduction. Parenteral nutrition-associated cholestasis is well recognized phenomenon in the term and preterm infant receiving long-term parenteral nutrition. Objectives. The aim of this study was to evaluate the effect of ursodeoxycholic acid (UDCA) use on cholestasis in newborns on prolonged TPN. Methods. A total of 56 infants were enrolled in this retrospective study: control group consisted of lower (1500 g) birth weight infants (n=30), as well as the group of pediatric (n=11) and surgical patients (n=15) treated with UDCA. Blood chemistries were obtained two times weekly. Results. All of 56 newborns developed cholestasis but duration of parenteral nutrition (PN) before onset of cholestasis was significantly longer in UDCA treated patients. Average duration of PN before the onset of cholestasis in control group of patients was 25 days in distinction from treated pediatric and surgical patients (39 and 34 days, respectively). The peak serum conjugated bilirubin (CB), AST, ALT and alkaline phosphatase (AP) levels were significantly lower in the treated groups. There was no significant difference among treated pediatric and surgical patients and between lower and higher birth weight infants considering the CB, ALT, AST and AP peak. Duration of cholestasis was significantly decreased in all treated groups. There was a significant difference in time needed to achieve complete enteral intake between pediatric and surgical patient group. Conclusion. Cholestasis developed significantly later in treated groups than in the controls. UDCA appears to be very successful in reducing the symptoms of cholestasis. The difference in efficacy of UDCA treatment between lower and higher birth weight infants could not be proven.

Keywords: parenteral nutrition, cholestasis, infants, ursodeoxycholic acid