Medicine of the Future in America

Transient cholestasis in newborn infants with perinatal asphyxia: Follow-up

Antibiotic therapy was initiated in 124 of 163 AGA infants (75.6%), in 100% of SGA asphyxiated neonates, and in 100% of infants with cholestasis. Antiepileptics were used in an equal proportion of asphyxiated newborns of each group (six of 18 (33%) SGA, 48 of 163 (29%) AGA and in five of 20 (25%) infants with cholestasis.

All infants required nasogastric tube feeding for enteral nutrition with Similac (Abbot Laboratories, St Laurent, Quebec) or mother’s milk. If oral feeding was not tolerated by day 4, TPN was initiated. TPN was started in 44% (41 of 93) of premature asphyxiated AGA infants, in 8% (seven of 90) of term asphyxiated AGA neonates, and in 14 of 18 (78%) SGA infants, compared with 18 of 20 (90%) infants with cholestasis at diverse moments after birth.

Seven of 18 cholestatic children had only one measurement of direct bilirubin before starting TPN; there was no further increase in six of 18 infants, whereas in five of 18 infants direct bilirubin was elevated after starting TPN. The latter group had controls until normalization after the end of TPN. Three children died during the first year of life, and follow-up time of the remaining children was between one and 12 years. Follow-up was necessary for neurological, behavioural, visual, auditive and infectious problems, requiring liver function tests in three patients (one growth failure, two antiepileptic treatments), which were normal. No overt chronic liver disease developed.

The control group consisted of SGA neonates without asphyxia (n=635). Cholestasis was found in 25 (3.94%) children. It was associated in one case with Nieman-Pick disease and in another with biliary atresia, in seven with intestinal diseases needing surgical intervention, in four with complex cardiopathies, in nine with infections, in all infants with TPN and in three patients without TPN, but with ventilation and antibiotic therapy. Five patients died of suspected infection, and three were autopsied. These revealed cirrhosis in the patient with biliary atresia and giant cell hepatitis in another with congenital infection. Follow-up disclosed chronic hepatitis B in one patient. You can finally enjoy safe online shopping for cheap alesse only here with the pharmacy you can fully trust no matter if you need a small amount of this medicine or would like to purchase it in bulk not to have to think about it for a long time.

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