Biomaterial Database

Infection and cholestasis in neonates with intestinal resection and long-term parenteral nutrition. 1998

J M Sondheimer, and E Asturias, and M Cadnapaphornchai

Department of Pediatrics, University of Colorado Health Sciences Center, Denver, USA.

OBJECTIVE This retrospective study was conducted to determine the incidence of cholestasis and liver failure in patients with intestinal resection in the neonatal period who subsequently become dependent on parenteral nutrition support and to assess the significance of associated clinical factors--gestational age, birth weight and length; length of bowel resected; presence of ileocecal valve; enteral feeding history; and infection--to the incidence and severity of cholestasis. METHODS Retrospective chart review of all patients in a single institution from May 1984 to February 1997 with neonatal small intestinal resection dependent on parenteral nutrition for at least 3 months. RESULTS Forty-two patients fitting the inclusion criteria were the subjects of this review. Cholestasis developed in 28 (67%) while they were receiving parenteral nutrition (direct serum bilirubin more than 2 mg/dl). In 21, the elevated direct bilirubin normalized while patients continued to receive parenteral nutrition. Seven patients progressed to liver failure. In 14 patients, serum direct bilirubin nerve rose above 2 mg/dl. The cholestatic patients did not differ from the noncholestatic in gestational age, birth weight, and length; primary diagnosis; length of bowel resected; or presence of ileocecal valve. The duration of dependence on parenteral nutrition was longer in noncholestatic (33.2 +/- 9 months) than in cholestatic patients progressing to liver failure (19.4 +/- 3 months) or in cholestatic patients who recovered (16.1 +/- 1.9 months) (p < 0.05). Invasive fungal or bacterial infections occurred in all but one noncholestatic patient. The number of infections per patient was similar in all groups. The mean age (days) at first infection was significantly younger in cholestatic patients progressing to liver failure (28.5 +/- 5) and cholestatic patients who recovered (48.2 +/- 14.2) than in noncholestatic patients (167 +/- 43.2) (p < 0.01). Infection preceded the onset of cholestasis in all but 3 patients by an average of 13.5 days. Infecting organisms and site of first infection were similar in all patients. CONCLUSIONS Cholestasis is common in infants with neonatal intestinal resection. Liver failure develops in 16.6%. Bacterial infection early in life characterized the cholestatic patients, and cholestasis developed shortly after the first infection in 90% of patients.

UI	MeSH Term	Description	Entries
D007231	Infant, Newborn	An infant during the first 28 days after birth.	Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D007422	Intestines	The section of the alimentary canal from the STOMACH to the ANAL CANAL. It includes the LARGE INTESTINE and SMALL INTESTINE.	Intestine
D010288	Parenteral Nutrition	The administering of nutrients for assimilation and utilization by a patient who cannot maintain adequate nutrition by enteral feeding alone. Nutrients are administered by a route other than the alimentary canal (e.g., intravenously, subcutaneously).	Intravenous Feeding,Nutrition, Parenteral,Parenteral Feeding,Feeding, Intravenous,Feeding, Parenteral,Feedings, Intravenous,Feedings, Parenteral,Intravenous Feedings,Parenteral Feedings
D011183	Postoperative Complications	Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery.	Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D002779	Cholestasis	Impairment of bile flow due to obstruction in small bile ducts (INTRAHEPATIC CHOLESTASIS) or obstruction in large bile ducts (EXTRAHEPATIC CHOLESTASIS).	Bile Duct Obstruction,Biliary Stasis,Bile Duct Obstructions,Biliary Stases,Cholestases,Duct Obstruction, Bile,Duct Obstructions, Bile,Obstruction, Bile Duct,Obstructions, Bile Duct,Stases, Biliary,Stasis, Biliary
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001424	Bacterial Infections	Infections by bacteria, general or unspecified.	Bacterial Disease,Bacterial Infection,Infection, Bacterial,Infections, Bacterial,Bacterial Diseases
D001663	Bilirubin	A bile pigment that is a degradation product of HEME.	Bilirubin IX alpha,Bilirubin, (15E)-Isomer,Bilirubin, (4E)-Isomer,Bilirubin, (4E,15E)-Isomer,Bilirubin, Calcium Salt,Bilirubin, Disodium Salt,Bilirubin, Monosodium Salt,Calcium Bilirubinate,Hematoidin,delta-Bilirubin,Bilirubinate, Calcium,Calcium Salt Bilirubin,Disodium Salt Bilirubin,Monosodium Salt Bilirubin,Salt Bilirubin, Calcium,delta Bilirubin
D012189	Retrospective Studies	Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.	Retrospective Study,Studies, Retrospective,Study, Retrospective
D012778	Short Bowel Syndrome	A malabsorption syndrome resulting from extensive operative resection of the SMALL INTESTINE, the absorptive region of the GASTROINTESTINAL TRACT.	Bowel Syndrome, Short,Bowel Syndromes, Short,Short Bowel Syndromes,Syndrome, Short Bowel,Syndromes, Short Bowel