Cholestatic Tendencies in Premature Infants on and off Parenteral Nutrition

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Abstract
The levels of serum conjugates of cholic acid (SCCA) were measured by radioimmunoassay in 32 newborn infants during the course of i.v. alimentation (study group 1, birth weight < 2 kg; study group 2, birth weight > 2 kg) and compared them to those of 2 groups of weight-matched control subjects and 1 group of normal infants and adults. Fasting SCCA levels in the 2 newborn control groups were significantly higher than those of normal infants and adults, and a significant postprandial elevation in SCCA level was present in the smaller of the 2 newborn control groups. During the 1st 2 wk of alimentation only 1 patient had an elevated SCCA level (> 2 SD above that of control subjects), without other abnormalities of liver function. In study group 1 patients who received alimentation for more than 2 wk, significant increases in mean peak SCCA level occurred and 7 of 8 patients had elevated levels. Three patients became jaundiced and had high alkaline phosphate values. Group 2 patients who received alimentation for more than 2 wk were unaffected. The appearance of liver abnormalities was related to body mass and duration of IV alimentation. The presence of documented or suspected sepsis, withholding of oral feedings, or the use of Intralipid could not be specifically related to SCCA levels. The small premature infant apparently has a limited hepatic excretory function and excretory immaturity is an important factor in the susceptibility of these infants to cholestasis associated with long-term IV alimentation.

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