Effect of Ursodeoxycholic Acid on Treating Parenteral Nutrition Associated Cholestasis in Premature Infants

Objective To observe the effect of ursodeoxycholic acid on treating premature infants with parenteral nutrition associated cholestasis(PNCA). Methods Sixty-five preterm newborns with PNCA from Mar.2005 to Mar.2011 were included in this study.They were divided into 3 groups based on different therapeutic doses of UDCA.Among them,24 cases were treated with high dosage of UDCA(20 mg·kg-1·d-1),and before treatment the alanine transaminase(ALT) was(73.5 ±31.9)U·L-1,glutamyltranspeptidase(GGT) was(107.5±27.9)U·L-1,and total bilirubin(TBIL) was(217.0±24.3) μmol·L-1,direct bilirubin(DBIL) was(71.8 ±18.8) μmol·L-1,total bile acid(TBA) was(61.5±18.2) μmol·L-1.Another 18 cases were treated with small dosage of UDCA(10 mg·kg-1·d-1),with the levels of ALT(76.8 ±32.1) U·L-1,GGT(116.8 ±29.8) U·L-1,TBIL(207.7± 20.8) μmol·L-1,DBIL(71.0 ±20.1) μmol·L-1,and TBA(63.9±19.8) μmol·L-1.Another 23 cases were not treated with UDCA,but with common treatment such as oral feeding as soon as possible,infection control,phasing out of parenteral nutrition,symptomatic treatment.As for the control group,the ALT was(70.3 ±33.8) U·L-1,GGT was(108.3 ±30.8) U·L-1,TBIL was(220.0 ±25.8) μmol·L-1,DBIL was(67.9 ±19.7) μmol·L-1,and TBA was(63.5±22.6) μmol·L-1.The liver function was compared among the 3 groups,2 to 4 weeks after treatment. Results Three cases were not included in assessment because they could not tolerate the high dose treatment and then turned to low dose of UDCA treatment.Other side effects such as allergic skin rash,diarrhea,hypoglycemia and leukocytosis were not observed in the UDCA treatment groups.Compared with the control group,the levels of ALT,GGT,TBIL,DBIL,TBA were lower in the low dose of UDCA treatment group(Pa0.05) and high dose of UDCA treatment group(Pa0.05) after 2 to 4 weeks of treatment.But there was no significant difference in the levels of high and low dose of UDCA treatment group(Pa0.05). Conclusion Low-dose UDCA treatment is significant and safe clinically for treating PNAC in preterm newborns.