AMINOSYN PF OR TROPHAMINE - WHICH PROVIDES MORE PROTECTION FROM CHOLESTASIS ASSOCIATED WITH TOTAL PARENTERAL-NUTRITION

Cholestasis often occurs in infants on total parenteral nutrition (TPN ) for long periods. Amino acid formulations developed specifically for infants, namely Aminosyn PF and Trophamine, may protect against chole stasis associated with total parenteral nutrition (CATPN). The develop ment of cholestasis may also be caused by other risk factors such as p rematurity, surgery, sepsis, and extracorporeal membrane oxygenation ( ECMO). To evaluate the relative effectiveness of the pediatric amino a cid formulations in reducing CATPN, the courses of 70 infants <1 year of age who received TPN for at least 14 days were reviewed. Cholestasi s was defined as a conjugated serum bilirubin greater than or equal to 2 mg/dl subsequent to the initiation of TPN; CATPN was considered pre sent when other factors related to cholestasis were ruled out. Liver f unction tests were recorded 24 h before starting TPN and at day 7, 15, and 21 during TPN infusion. Thirty infants (42.8%) developed cholesta sis. CATPN was judged to have occurred in 15 (21.4%) of 70 infants, wh ile 15 (21.4%) developed cholestasis secondary to other factors. Of th e 15 CATPN patients, 7 had received Trophamine, 6 had received Aminosy n PF, and 2 had received both solutions. Aminosyn PF and Trophamine, a long with other potential risk factors for CATPN such as antecedent su rgery, sepsis, ECMO, prematurity, and nitrogen/calorie intake were ana lyzed by regression-analysis methods. None was statistically significa nt except the length of TPN (p = 0.0063). In conclusion, we cannot sup port the view that Trophamine is more effective than Aminosyn PF in th e prevention of CATPN.