Guest sageaugie Posted October 25, 2012 Share Posted October 25, 2012 How frequent is the incidence of cholestatic jaundice associated with TPN? In my own experience almost all babies, whom we had started on TPN, developed cholestatic jaundice. Link to comment Share on other sites More sharing options...
Dinesh N Patel Posted October 28, 2012 Share Posted October 28, 2012 I agree with you l have come across to cholestatic jaundice in ELBW Infants two times with TPN for _?more than 3wks with NEC. Both received intralipids and NBM for more than 15 days. Both improvement with time , treated with ursodiliol, vitamin suppliment(A D, E, K) and supportive care. We have rulled out other cause of cholestatic jaundice in newborn Link to comment Share on other sites More sharing options...
Guest sageaugie Posted October 29, 2012 Share Posted October 29, 2012 I have noticed cholestasis even with short term PN. Most of them resolved with initiation of enteral feeds. In your experience what has been the highest blirubin levels that you would have come across with TPN? Link to comment Share on other sites More sharing options...
Stefan Johansson Posted October 30, 2012 Share Posted October 30, 2012 Cholestatic jaundice is fairly common in my experience, among very preterm infants given TPN for shorter or longer periods of time. Depending on the dynamics of the s-bili, we do nothing but follow s-bili over time until it resolves (which is should do if the diagnosis is correct). If the s-bili is high or is increasing we medicate the baby with vitamin-K (0.1 mg/kg x1) , vitamin-E (7.5 mg/kgx2) and ursodeoxycholic acids (typically 10-15 mg/kg x 3), while following s-bili. Link to comment Share on other sites More sharing options...
Bmurbati Posted October 31, 2012 Share Posted October 31, 2012 the TPN related cholestasis is common in long term TPN, however it ca be delayed if the TPN used carefully, it is unlikely to see cholestatic jaundice before 4-6weeks of starting TPN. but if you are careful it can be delayed for 6 and even 12 months after initiating the TPN and this is few tips to decrease the risk like -- 1- give cyclic TPN 2- alternative days lipids 3- protein not to exceeds 2.5g/kg/day 4- recurrent sepsis increase the risk of choestasis 4- start the treatment early as mentioned by Stefan Johansson Link to comment Share on other sites More sharing options...
Dinesh N Patel Posted November 5, 2012 Share Posted November 5, 2012 ThanksBmurbati for giving some tips for preventing cholastasis,. I want to add 1-there are some study that Omegwin has prentive role for cholastasis if you cycle with intralipids. 2-Start trophic feeding as early possile as NBM for prolong period(>7days)is usualy associated with Cholastasis. the highest s.bilirun level icame accross was 19 mg/dl in a pt with NEC With septisemia and NBM for 15 days.,recover complitely with supportive care and Ursioiol Link to comment Share on other sites More sharing options...
Guest sageaugie Posted November 11, 2012 Share Posted November 11, 2012 Thanks Bmurbati and Dinesh for sharing these tips Link to comment Share on other sites More sharing options...
Guest randa Posted December 4, 2012 Share Posted December 4, 2012 Thanks aloooooooooooooooooooooooot Bmurbati and Dinesh for sharing these usefull informations Link to comment Share on other sites More sharing options...
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