Medicine of the Future in America

Transient cholestasis in newborn infants with perinatal asphyxia: DISCUSSION

Neonatal cholestasisNeonatal cholestasis is a condition that demands extensive work-up to exclude inborn errors of metabolism, intrauterine infections, endocrine dysfunction or malformation. Frequently, these investigations do not yield positive findings, and if the cholestasis resolves spontaneously, the condition is called transient neonatal cholestasis. Asphyxiated infants seem to be at risk for this type of transient cholestasis. The present study defines the incidence of transient neonatal cholestasis in asphyxiated infants.

Transient neonatal cholestasis was found in 8.5% of AGA and in 33% of SGA asphyxiated neonates. Cholestatic neonates of both groups were severely affected, as shown by longer periods of mechanical ventilation and a larger number of patients requiring antibiotic therapy and TPN, when compared with asphyxiated newborns without cholestasis.

It therefore seems that severe illness is an additional risk factor for the development of cholestasis in asphyxiated neonates. Other factors, such as family or pregnancy history, could not explain the severe perinatal illness or the occurrence of cholestasis in these neonates. Prematurely-born infants were more frequently cholestatic than children born at term, but the difference by univariate analysis was significant only in AGA infants. Multivariate analysis showed an increased risk for all infants born before the age of 35 weeks. Using data from the same registry, we found that elevated direct bilirubin, including all etiologies, occurred in 3.9% of nonasphyxiated SGA neonates, and transient neonatal cholestasis in three (4%o). The mechanism leading to cholestasis in asphyxia is not well understood. It is thought to be of multifactorial origin. Inefficient enterohepatic circulation, immaturity of bile secretion and lack of enteral nutrition may combine with fetal distress and reduced splanchnic blood flow, inducing poor oxygenation of the liver and bowel. The subsequent decreased expression of bile acid transport proteins of basolateral and apical hepatocyte membranes may further impair the immature secretion of bile acids and enhance physiological cholestasis in the neonate. Get most advantageous deals offered to you by the pharmacy you are going to appreciate soon after you become its customer: you now can get your cheap mircette buy now any time of the day or night with very fast delivery and quality guarantees.

This entry was posted in Transient cholestasis and tagged Asphyxia, Cholestasis, Newborn.
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