Parenteral Nutrition-Associated Liver Disease: a Retrospective Study of Ursodeoxycholic Acid Use in Neonates

Thibault, Maxime; McMahon, Jessica; Faubert, Guillaume; Charbonneau, J; Malo, Josianne; Ferreira, Ema; Mohamed, Ibrahim

doi:10.5863/1551-6776-19.1.42

Cited by 10 publications

(8 citation statements)

References 21 publications

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“…No estudo de Chen et al 14 realizado com 30 RN prematuros de baixo peso e com doença hepática relacionada à nutrição parenteral admitidos no Hospital Nacional da Universidade de Taiwan, 12 RN no grupo de tratamento e 18 no grupo controle, os pacientes que receberam terapia com UDCA apresentaram um período significativamente mais curto de colestase do que aqueles no grupo controle (62.8 vs 92.4 dias, p = 0,006) 14 . Já em um estudo retrospectivo maior e mais recente de Thibault et al 19 , a terapia com UDCA não foi associada à duração da doença hepática associada à nutrição parenteral. De 118 lactentes elegíveis, 64 receberam UDCA; nestes a colestase durou mais tempo (79 vs. 50 dias, p = 0,001).…”

Section: Resultsunclassified

“…De 118 lactentes elegíveis, 64 receberam UDCA; nestes a colestase durou mais tempo (79 vs. 50 dias, p = 0,001). No entanto, o grupo de tratamento foi significativamente menor e englobavam prematuros extremos, o que é uma grande limitação do estudo 19 . Portanto, embora não haja dados na literatura que comprovem o real benefício do uso de UDCA, a medicação é comumente utilizada na prática clínica.…”

Section: Resultsunclassified

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Evolução laboratorial da colestase multifatorial em pacientes pediátricos

Éboli

Duarte

Albuquerque

et al. 2019

Rev. Med. (São Paulo)

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Introdução: No fígado imaturo do recém-nascido (RN) a colestase neonatal pode ocorrer em associação a um ou vários fatores de risco, sem patologia subjacente. Esta condição denomina-se colestase neonatal multifatorial transitória. Prematuridade, restrição de crescimento intra-uterino ou situações que levam a maior estresse oxidativo (isquemia, comprometimento hemodinâmico, infecções, intervenções cirúrgicas, pausa alimentar, alimentação parenteral e fármacos) estão relacionadas com sua gênese. Objetivo: Avaliar a evolução da colestase neonatal multifatorial quanto a sua duração, assim como verificar as alterações médias das enzimas hepáticas, aspartato aminotransferase (AST), alanina aminotransferase (ALT), e canaliculares, gamaglutamiltransferase (GGT), e da bilirrubina direta (BD), comparando ainda a duração da colestase nos pacientes que fizeram uso do ácido ursodesoxicólico (UDCA) com o tempo de evolução dos que não o fizeram, no intuito de caracterizar melhor essa condição clínica e de chamar a atenção do profissional de saúde sobre sua natureza transitória, evitando dessa maneira a solicitação de exames mais específicos, onerosos e desnecessários. Método: Estudo transversal, com 32 pacientes de zero a 90 dias que apresentavam colestase neonatal multifatorial, acompanhados no ambulatório de hepatologia pediátrica do IMIP, no período de agosto de 2016 a agosto de 2017. Os dados foram coletados através de consulta ao prontuário. A análise estatística dos dados foi realizada por meio do software “R” v.3.3.1. Resultados: A maioria dos pacientes era do sexo masculino (59,38%). A idade média de início da colestase foi de 35,5 dias, e a de término de 171,3 dias. A média de duração da colestase foi de 135,8 dias. O valor médio da BD do início e término da colestase foi de 6,05 e 0,29 mg/dL, respectivamente. Com relação às enzimas hepáticas e canaliculares, as médias dos valores de AST, ALT e GGT do início foram 194,7, 123,8 e 387,9 U/L, e de término 69,1, 56 e 121,6 U/L, respectivamente. Apenas 11 pacientes fizeram uso do UDCA. O tempo médio de duração da colestase neste grupo foi de 114,1 dias. Aqueles que não usaram o UDCA, 21 pacientes, apresentaram icterícia colestática por um tempo médio de 147,1 dias. Conclusão: Diante dos resultados obtidos com a análise retrospectiva dos pacientes com diagnóstico de colestase multifatorial, chama a atenção a natureza transitória e benigna desta condição clínica, com duração média da colestase em torno de 136 dias de vida e declínio importante dos níveis das enzimas hepáticas e canaliculares após resolução do quadro

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Section: Resultsunclassified

Evolução laboratorial da colestase multifatorial em pacientes pediátricos

Éboli

Duarte

Albuquerque

et al. 2019

Rev. Med. (São Paulo)

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“…PNALD is a multifactorial disease entity and other factors such as inflammation and sepsis in the small bowel can contribute to the severity of cholestasis. The level of inflammatory mediators [16] may be influenced by other treatment factors as well, such as the use of ursodeoxycholic acid [17] or antibiotics for management of sepsis.…”

Section: Discussionmentioning

confidence: 99%

Influence of Soybean Oil or Non-Soybean Oil Based Lipid Emulsions on Parenteral Nutrition Associated Liver Disease in Late Preterm and Term Infants

Trivedi¹,

Wong²,

Walker³

et al. 2014

Int. J. Child Health Nutr.

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Background: Total parenteral nutrition (TPN) is a life-saving therapy given to neonates with intestinal failure. However, infants on long-term TPN may experience Parenteral Nutrition-Associated Liver Disease (PNALD). New formulations for lipid emulsions are purportedly better than the traditional soy-based lipid emulsions (SLE). Our primary objective was to determine the prevalence of PNALD in infants who received non-soybean-based lipid emulsions (NSLE) or SLE. Methods: In this retrospective study, medical records of all infants admitted to a tertiary neonatal intensive care unitfrom 2004 to 2013 were reviewed. Late preterm (34-36 weeks of gestation) and term infants who were on TPN for more than two weeks were included. Their demographic data and clinical variables were collected. Results: 208 infants received SLE for more than two weeks. The prevalence rate of PNALD in those who received SLE was 21% while that of those who received the NSLE was 17%. No significant difference was found between the 'Soy' or 'NonSoy' subgroups (p = 0.315). Seventy infants received TPN for more than four weeks. The prevalence rate of PNALD in infants who received SLE and NSLE was 35% and 25% respectively. No significant statistical difference was found between the 'Soy' or 'NonSoy' subgroups (p = 0.132). Conclusions: The type of lipid emulsion does not significantly influence the rate of PNALD in late preterm and term infants on long-term TPN.

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“…Following the discoveries of the associations of PN with liver disease, several strategies were adopted to limit and reverse the damage inflicted by PN. These strategies included cycling of PN and use of choleretic agents, such as ursodeoxycholic acid and cholecystokinin, all of which yielded very limited success 15 – 17 . One strategy that has been more effective in limiting liver disease is the fat‐lowering strategy, where SOFE is given at a reduced dose of 1–1.5 g/kg/d instead of the regular dose of 3–3.5 g/kg/d.…”

Section: Ivfes and Pnaldmentioning

confidence: 99%

Emerging Clinical Benefits of New‐Generation Fat Emulsions in Preterm Neonates

2017

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Soybean oil-based intravenous fat emulsions (IVFEs) have been the predominant parenteral nutrition IVFE used in the United States for neonates over the past 45 years. Even though this emulsion has proven useful in supplying infants with energy for growth and essential fatty acids, there have been concerns over its composition in the development of several morbidities, ranging from sepsis to liver disease, bronchopulmonary dysplasia, and impaired neurodevelopment and growth. The exact mechanisms that drive these morbidities in preterm infants are multifactorial, but potential contributors include high ω-6 (n-6) fatty acid composition, low docosahexaenoic acid and antioxidant supplementation, and the presence of potentially harmful nonnutritive components (eg, phytosterols). To address these issues, new-generation IVFEs with various types and amounts of fat have been developed containing greater amounts of the medium-chain fatty acids, long-chain polyunsaturated fatty acid, docosahexaenoic acid, lower concentrations of ω-6 polyunsaturated fatty acids, supplemental vitamin E, and low or negligible amounts of phytosterols. This review examines the clinical outcomes associated with different morbidities of parenteral nutrition in neonates who have received either soybean oil-based or new-generation IVFEs and addresses whether the proposed benefits of new-generation IVFEs have improved outcomes in the neonatal population.

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Parenteral Nutrition-Associated Liver Disease: a Retrospective Study of Ursodeoxycholic Acid Use in Neonates

Abstract: UDCA therapy was not associated with the duration of parenteral nutrition-associated liver disease. A delay in treatment initiation might explain this result. UDCA therapy was associated with a faster decline of conjugated bilirubin and greater weight gain.

Cited by 10 publications

References 21 publications

Evolução laboratorial da colestase multifatorial em pacientes pediátricos

Evolução laboratorial da colestase multifatorial em pacientes pediátricos

Influence of Soybean Oil or Non-Soybean Oil Based Lipid Emulsions on Parenteral Nutrition Associated Liver Disease in Late Preterm and Term Infants

Emerging Clinical Benefits of New‐Generation Fat Emulsions in Preterm Neonates

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