Sondheimer J M, Asturias E, Cadnapaphornchai M
Department of Pediatrics, University of Colorado Health Sciences Center, Denver, USA.
J Pediatr Gastroenterol Nutr. 1998 Aug;27(2):131-7. doi: 10.1097/00005176-199808000-00001.
This retrospective study was conducted to determine the incidence of cholestasis and liver failure in patients with intestinal resection in the neonatal period who subsequently become dependent on parenteral nutrition support and to assess the significance of associated clinical factors--gestational age, birth weight and length; length of bowel resected; presence of ileocecal valve; enteral feeding history; and infection--to the incidence and severity of cholestasis.
Retrospective chart review of all patients in a single institution from May 1984 to February 1997 with neonatal small intestinal resection dependent on parenteral nutrition for at least 3 months.
Forty-two patients fitting the inclusion criteria were the subjects of this review. Cholestasis developed in 28 (67%) while they were receiving parenteral nutrition (direct serum bilirubin more than 2 mg/dl). In 21, the elevated direct bilirubin normalized while patients continued to receive parenteral nutrition. Seven patients progressed to liver failure. In 14 patients, serum direct bilirubin nerve rose above 2 mg/dl. The cholestatic patients did not differ from the noncholestatic in gestational age, birth weight, and length; primary diagnosis; length of bowel resected; or presence of ileocecal valve. The duration of dependence on parenteral nutrition was longer in noncholestatic (33.2 +/- 9 months) than in cholestatic patients progressing to liver failure (19.4 +/- 3 months) or in cholestatic patients who recovered (16.1 +/- 1.9 months) (p < 0.05). Invasive fungal or bacterial infections occurred in all but one noncholestatic patient. The number of infections per patient was similar in all groups. The mean age (days) at first infection was significantly younger in cholestatic patients progressing to liver failure (28.5 +/- 5) and cholestatic patients who recovered (48.2 +/- 14.2) than in noncholestatic patients (167 +/- 43.2) (p < 0.01). Infection preceded the onset of cholestasis in all but 3 patients by an average of 13.5 days. Infecting organisms and site of first infection were similar in all patients.
Cholestasis is common in infants with neonatal intestinal resection. Liver failure develops in 16.6%. Bacterial infection early in life characterized the cholestatic patients, and cholestasis developed shortly after the first infection in 90% of patients.
开展这项回顾性研究以确定新生儿期接受肠切除术后依赖肠外营养支持的患者胆汁淤积和肝衰竭的发生率，并评估相关临床因素——胎龄、出生体重和身长；切除肠段的长度；回盲瓣的存在情况；肠内喂养史；以及感染——对胆汁淤积发生率和严重程度的影响。
对1984年5月至1997年2月期间在单一机构中所有接受新生儿小肠切除且依赖肠外营养至少3个月的患者进行回顾性病历审查。
符合纳入标准的42例患者纳入本综述。28例（67%）在接受肠外营养期间出现胆汁淤积（直接血清胆红素超过2mg/dl）。21例患者在继续接受肠外营养时，升高的直接胆红素恢复正常。7例患者进展为肝衰竭。14例患者血清直接胆红素从未升至2mg/dl以上。胆汁淤积患者与非胆汁淤积患者在胎龄、出生体重、身长、初步诊断、切除肠段长度或回盲瓣存在情况方面无差异。非胆汁淤积患者依赖肠外营养的时间（33.2±9个月）比进展为肝衰竭的胆汁淤积患者（19.4±3个月）或恢复的胆汁淤积患者（16.1±1.9个月）更长（p<0.05）。除1例非胆汁淤积患者外，所有患者均发生侵袭性真菌或细菌感染。所有组中每位患者的感染次数相似。进展为肝衰竭的胆汁淤积患者（28.5±5）和恢复的胆汁淤积患者（48.2±14.2）首次感染时的平均年龄（天）显著低于非胆汁淤积患者（167±43.2）（p<0.01）。除3例患者外，所有患者感染均先于胆汁淤积发生，平均提前13.5天。所有患者的感染病原体和首次感染部位相似。
新生儿肠切除术后的婴儿中胆汁淤积很常见。肝衰竭发生率为16.6%。生命早期的细菌感染是胆汁淤积患者的特征，90%的患者在首次感染后不久出现胆汁淤积。
