PARENTERAL NUTRITION-ASSOCIATED CHOLESTASIS IN NEONATES: MULTIVARIATE ANALYSIS OF THE POTENTIAL PROTECTIVE EFFECT OF TAURINE

Authors: SPENCER, ARIEL - UNIV OF MICHIGAN; YU, SUNKYUNG - UNIV OF MICHIGAN; TRACY, THOMAS - BROWN UNIVERSITY; AOUTHAMANY, MOUSTAFA - ST VENCENT'S MERCY HOSP; LLANOS, ADOLFO - STRONG MEMORIAL HOSP; BROWN, MORTON - UNIV OF MICHIGAN; BROWN, MARILYN - UNIV OF ROCHESTER; Shulman, Robert; HIRSCHL, RONALD - UNIV OF MICHIGAN; DERUSSO, PATRICIA - JOHNS HOPKINS U SCH MED; COX, JEAN - JOHNS HOPKINS U SCH MED; DAHLGREN, JACQUELINE - UNIV OF MICHIGAN; STROUSE, PETER - UNIV OF MICHIGAN; GRONER, JONATHAN - COLUMBUS CHILDREN'S HOSP; TEITELBAUM, DANIEL - UNIV OF MICHIGAN

Submitted to: Journal of Parenteral and Enteral Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/24/2005
Publication Date: 9/1/2005
Citation: Spencer, A.U., Yu, S., Tracy, T.F., Aouthamany, M.M., Llanos, A., Brown, M.B., Brown, M., Shulman, R.J., Hirschl, R.B., Derusso, P.A., Cox, J., Dahlgren, J., Strouse, P.J., Groner, J.I., Teitelbaum, D.H. 2005. Parenteral nutrition-associated cholestasis in neonates: multivariate analysis of the potential protective effect of taurine. Journal of Parenteral and Enteral Nutrition. 29(5):337-344.

Interpretive Summary: Parenteral nutrition is a method of feeding patients through an intravenous catheter. It can be a life saving technique. However, particularly in premature infants, it can cause severe liver disease in association with other factors such as infection. How this occurs is not known. Taurine is an amino acid that is felt to be important in the nutrition of premature infants. It forms part of the pathway for the liver to excrete its products. This study investigated the ability of taurine to protect against liver disease associated with parenteral nutrition when the amino acid is provided in greater amounts than is usually done. The results indicate that supplementation with additional amounts of taurine can help protect premature infants from getting liver disease associated with parenteral nutrition.

Technical Abstract: Background: Neonates receiving parenteral nutrition (PN) are at risk for PN-associated cholestasis (PNAC); however, no preventive factors for PNAC have been clearly identified. Despite reports suggesting that taurine may prevent PNAC in neonates, such an effect of taurine has not yet been definitively demonstrated. We determined whether taurine supplementation reduces the incidence of PNAC in premature or critically ill neonates. Methods: This study was part of a prospective, randomized, multi-institutional trial designed to assess cholecystokinin vs placebo as a potential preventive therapy of PNAC. Taurine supplementation of PN varied between institutions. The presence or absence of taurine in PN was analyzed by multivariate analysis, with a primary outcome measure of serum conjugated bilirubin (CB) as a measure of PNAC. Results: Taurine reduced PNAC in premature infants (estimated maximum CB [95% confidence interval] 0.50 mg/dL [-0.17 to 1.18] for those receiving taurine, vs 3.45 mg/dL [1.79-5.11] for neonates not receiving taurine, approaching significance, (p = .07). Taurine significantly reduced PNAC in infants with necrotizing enterocolitis (NEC; estimated maximum CB 4.04 mg/dL [2.85-5.23], NEC infants receiving taurine, vs 8.29 mg/dL [5.61-10.96], NEC infants not receiving taurine, (p < .01). There were too few neonates with surgical anomalies to evaluate the effect of taurine in this group. Conclusions: Within specific subgroups of neonatal patients, taurine supplementation does offer a very significant degree of protection against PNAC. Patients with NEC or severe prematurity are most likely to benefit substantially from taurine supplementation.