Jacquemin E, Maurage C, Borderon J C, Gold F, Laugier J, Rolland J C
Gastroenterology Unit, Clocheville Children's Hospital, Tours, France.
Eur J Pediatr Surg. 1995 Oct;5(5):259-61. doi: 10.1055/s-2008-1066219.
We report 18 premature infants (gestational age: 31.1 weeks +/- 2.6 [mean +/- SD] (range: 28-36]) with necrotizing enterocolitis (NEC) who developed total parenteral nutrition (TPN) associated cholestasis. Liver function tests were performed at the start of TPN (D1) and repeated once a week. Considering the date of cholestasis onset (direct bilirubin > 30 mumol/l and/or serum bile salts > 10 mumol/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 occurred prior to D1 and were the only risk factors of cholestasis identified before D1. The second group consisted of 9 patients who developed cholestasis after D1 and in whom the cause of cholestasis was multifactorial (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.
我们报告了18例患有坏死性小肠结肠炎（NEC）的早产儿（胎龄：31.1周±2.6 [均值±标准差]（范围：28 - 36周）），他们发生了全胃肠外营养（TPN）相关胆汁淤积。在TPN开始时（第1天）进行肝功能检查，并每周重复一次。根据胆汁淤积开始日期（直接胆红素> 30 μmol/l和/或血清胆汁盐> 10 μmol/l），患者可分为两组。第一组由9例在第1天出现胆汁淤积的患者组成。在这些患者中，休克和/或缺氧在第1天之前发生，并且是第1天之前确定的胆汁淤积的唯一危险因素。第二组由9例在第1天之后出现胆汁淤积的患者组成，这些患者胆汁淤积的原因是多因素的（败血症、缺乏肠内喂养、休克和/或缺氧）。这些结果表明，休克和/或缺氧可能是早产儿早期胆汁淤积的原因。我们得出结论，在讨论TPN相关胆汁淤积时应考虑休克和缺氧。
