HOME HELP CONTACT US SUBSCRIPTIONS CME ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) E-Letters: Submit a response Alert me when this article is cited Alert me when E-Letters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Colby, C. Articles by Lang, T. Search for Related Content PubMed Articles by Colby, C. Articles by Lang, T.

NeoReviews Vol.8 No.12 2007 e547
© 2007 American Academy of Pediatrics

Pharmacology Review

Pharmacotherapy for the Treatment of Parenteral Nutrition-associated Cholestasis

Christopher Colby, MD^*
Tyler Hartman, MD
Tara Lang, MD

^* Assistant Professor of Pediatrics, Division of Neonatology, Mayo Clinic, Rochester, Minn
Pediatric Resident, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn

The first 300 words of the full text of this article appear below.

	Case Study

 
A male infant was born at 26 6/7 weeks’ gestation to a 38-year-old woman whose pregnancy was complicated by premature rupture of membranes at 20 weeks’ gestation and placental abruption. The infant's birthweight was 910 g and Apgar scores were 5 and 7 at 1 and 5 minutes, respectively. He developed feeding intolerance and experienced four episodes of medically managed suspected necrotizing enterocolitis. He required parenteral nutrition (PN) for a total of 71 days and received full enteral feedings throughout the remainder of his hospitalization without evidence of acholic stools. On postnatal day 42, he developed jaundice, but the remainder of his physical examination findings were normal. Laboratory values at that time included a total bilirubin of 3.3 mg/dL (56.4 mcmol/L) and direct bilirubin of 2.6 mg/dL (44.5 mcmol/L).

The jaundice continued to progress, and on postnatal day 72, total bilirubin measured 9.5 mg/dL (162.5 mcmol/L) and direct bilirubin measured 6.4 mg/dL (109.5 mcmol/L). Abdominal ultrasonography revealed a liver and gallbladder of normal size and echotexture. Doppler flow evaluation demonstrated patency of the hepatic veins and inferior vena cava. The common bile duct was identified and measured 1 mm in diameter. Ursodeoxycholic acid (UDCA) (20 mg/kg per day) was started. The laboratory studies were negative for coagulopathy and glucose lability. Mild elevation of alanine aminotransferase (43 to 108 U/L) and elevated gamma-glutamyl transferase (250 to 256 U/L) were noted. Assessments for cystic fibrosis, alpha-1-antitrypsin deficiency, neonatal iron storage disease, and bile acid synthesis disorders returned negative results. A HIDA scan performed on postnatal day 74 revealed no obvious flow into the intestine, and phenobarbital (5 mg/kg per day) was started.

Despite full enteral nutrition and treatment with UDCA and phenobarbital, the direct bilirubin continued to increase to 12.1 mg/dL (206.9 mcmol/L) on postnatal day 97. A repeat HIDA . . . [Full Text of this Article]