EARLY CHOLESTASIS IN PREMATURE-INFANTS RECEIVING TOTAL PARENTERAL-NUTRITION - A POSSIBLE CONSEQUENCE OF SHOCK AND HYPOXIA

We report 18 premature infants (gestational age: 31.1 weeks +/- 2.6 [m ean +/- SD] [range: 28-36]) with necrotizing enterocolitis (NEC) who d eveloped total parenteral nutrition (TPN) associated cholestasis. Live r function tests were performed at the start of TPN (D1) and repeated once a week. Considering the date of cholestasis onset (direct bilirub in > 30 mu mol/l and/or serum bile salts > 10 mu mol/l), the patients can be divided in two groups. The first group consisted of 9 patients who had cholestasis at D1. In these patients shock and/or hypoxia occu rred prior to D1 and were the only risk factors of cholestasis identif ied before D1. The second group consisted of 9 patients who developed cholestasis after D1 and in whom the cause of cholestasis was multifac torial (sepsis, lack of enteral feeding, shock and/or hypoxia). These results suggest that shock and/or hypoxia can be responsible for early cholestasis in premature infants. we conclude that shock and hypoxia should be considered when discussing TPN-associated cholestasis.