Evidence for Amino Acid Induced Cholestasis in Very‐low‐birth‐weight Infants with Increasing Enteral Protein Intake

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Abstract
In the present investigation 32 very-low-birth-weight (VLBW) infants fed at three different levels of protein intake (2.92 g/kg/d from human milk, 3.22 and 4.06 g/kg/d from formula) were studied at the mean age of 21 days. Serum total .alpha.-amino nitrogen concentration correlated directly to total bile acid concentration. The serum and urine .alpha.-amino nitrogen and the serum bile acid concentration correlated with protein intake. The increase in protein intake was accompanied by a concomitant decrease in the intraluminal bile acid concentration in the AGA infants. The results offer indirect evidence of decreased bile flow in VLBW-infants on excessive oral protein intake. The cholestatic effect could be mediated by an increase in the plasma amino acid concentration.