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Pediatric Surgery International

Published in:

01-03-2019 | Original Article

Direct hyperbilirubinemia in newborns with gastroschisis

Authors: Sarah B. Cairo, Alex H. Osak, Sara K. Berkelhamer, Cara McLaughlin, David H. Rothstein

Published in: Pediatric Surgery International | Issue 3/2019

Abstract

Background

Patients with gastroschisis and prolonged total (or partial) parenteral nutrition (PN) commonly develop direct hyperbilirubinemia (DH).

Objective

To quantify the prevalence and severity of DH in newborns with gastroschisis and characterize the diagnostic work-up for DH in this patient population.

Design/Methods

Retrospective chart review of patients born with gastroschisis between 2005 and 2015 for the first 6 months of life.

Results

29 patients were identified with gastroschisis. Mean gestational age and birthweight were 36.4 (± 1.8) weeks and 2.5 (± 0.6) kg. 41% were treated with primary reduction versus staged closure. Peak total and direct bilirubin (DB) levels were 10.17 ± 6.21 mg/dL and 5.58 ± 3.94 mg/dL, respectively. 23 patients (79.3%) were diagnosed with DH and 78.2% underwent additional work-up for hyperbilirubinemia consisting of imaging and laboratory studies, none of which revealed a cause for DH other than the presumed PN-associated cholestasis. In all patients, DB began to decline within 1–10 days of initiation of enteral feeds.

Conclusion(s)

DH is common in patients with gastroschisis and is unlikely to be associated with pathology aside from PN. Additional work-up may lead to unnecessary resource utilization.

Levels of evidence

Case series with no comparison group, Level IV.

Akgür FM, Ozdemir T, Olguner M, Aktuğ T, Ozer E (1998) An experimental study investigating the effects of intraperitoneal human neonatal urine and meconium on rat intestines. Res Exp Med (Berl) 198(4):207–213CrossRef

Aljahdali A, Mohajerani N, Skarsgard ED, (CAPSNet), CPSN (2013) Effect of timing of enteral feeding on outcome in gastroschisis. J Pediatr Surg 48(5):971–976. https://doi.org/10.1016/j.jpedsurg.2013.02.014 CrossRefPubMed

Atkison PR, Ross BC, Williams S, Howard J, Sommerauer J, Quan D, Wall W (2002) Long-term results of pediatric liver transplantation in a combined pediatric and adult transplant program. CMAJ 166(13):1663–1671PubMedPubMedCentral

Beath S, Kelly D (2016) Total parenteral nutrition–induced cholestasis: prevention and management. 20(1):159–176. https://doi.org/10.1016/j.cld.2015.08.009

Bhutani VK, Stark AR, Lazzeroni LC, Poland R, Gourley GR, Kazmierczak S (2013) Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. J Pediatr 162(3):477–482.e471. https://doi.org/10.1016/j.jpeds.2012.08.022 CrossRefPubMed

Buchman AL, Moukarzel AA, Bhuta S, Belle M, Ament ME, Eckhert CD,.. . Vijayaroghavan SR (1995) Parenteral nutrition is associated with intestinal morphologic and functional changes in humans. JPEN 19(6):453–460. https://doi.org/10.1177/0148607195019006453 CrossRef

Chou SC, Palmer RH, Ezhuthachan S, Newman C, Pradell-Boyd B, Maisels MJ, Testa MA (2003) Management of hyperbilirubinemia in newborns: measuring performance by using a benchmarking model. Pediatrics 112(6 Pt 1):1264–1273CrossRefPubMed

Diamanti A, Basso MS, Castro M, Calce A, Pietrobattista A, Gambarara M (2007) Prevalence of life-threatening complications in pediatric patients affected by intestinal failure. Transplant Proc 39(5):1632–1633. https://doi.org/10.1016/j.transproceed.2007.02.083 CrossRefPubMed

Diamond IR, de Silva N, Pencharz PB, Kim JH, Wales PW (2007) Neonatal short bowel syndrome outcomes after the establishment of the first Canadian multidisciplinary intestinal rehabilitation program: preliminary experience. J Pediatr Surg 42(5):806–811. https://doi.org/10.1016/j.jpedsurg.2006.12.033 CrossRefPubMed

10.

Fallon EM, Mitchell PD, Potemkin AK, Nehra D, Arsenault DA, Robinson EM, Puder M (2012) Cholestasis and growth in neonates with gastroschisis. J Pediatr Surg 47(8):1529–1536. https://doi.org/10.1016/j.jpedsurg.2011.12.028 CrossRefPubMed

11.

Fawaz R, Baumann U, Ekong U, Fischler B, Hadzic N, Mack CL, Karpen SJ (2017) Guideline for the evaluation of cholestatic jaundice in infants: joint recommendations of the North American Society for pediatric gastroenterology, hepatology, and nutrition and the european society for pediatric gastroenterology, hepatology, and nutrition. J Pediatr Gastroenterol Nutr 64(1):154–168. https://doi.org/10.1097/MPG.0000000000001334 CrossRefPubMed

12.

Gonzalez DO, Cooper JN, Peter SDS, Minneci PC, Deans KJ (2017) Variability in outcomes after gastroschisis closure across U.S. children’s hospitals. J Pediatr Surg. https://doi.org/10.1016/j.jpedsurg.2017.04.012 CrossRefPubMed

13.

Gottesman LE, Vecchio DMT, Aronoff SC (2015) Etiologies of conjugated hyperbilirubinemia in infancy: a systematic review of 1692 subjects. BMC Pediatr 15:192. https://doi.org/10.1186/s12887-015-0506-5 CrossRefPubMedPubMedCentral

14.

Guglielmi FW, Regano N, Mazzuoli S, Fregnan S, Leogrande G, Guglielmi A, Francavilla A (2008) Cholestasis Induced by Total Parenteral Nutrition. 12(1), 97–110. https://doi.org/10.1016/j.cld.2007.11.004

15.

Gulack BC, Laughon MM, Clark RH, Burgess T, Robinson S, Muhammad A, Smith PB (2016) Enteral feeding with human milk decreases time to discharge in infants following gastroschisis repair. J Pediatr 170:85–89. https://doi.org/10.1016/j.jpeds.2015.11.046 CrossRefPubMed

16.

Howat JM, Wilkinson AW (1970) Functional intestinal obstruction in the neonate. Arch Dis Child 45(244):800–804CrossRefPubMedPubMedCentral

17.

Indrio F, Raimondi F, Laforgia N, Riezzo G, Polimeno L, Francavilla R (2007) Effect of hyperbilirubinemia on intestinal permeability in healthy term newborns. Acta Paediatr 96(1):73–75. https://doi.org/10.1111/j.1651-2227.2006.00007.x CrossRefPubMed

18.

Jancelewicz T, Barmherzig R, Chung C, Ling S, Kamath B, Ng V, Langer J (2015) A screening algorithm for the efficient exclusion of biliary atresia in infants with cholestatic jaundice. 50(3), 363–370. https://doi.org/10.1016/j.jpedsurg.2014.08.014

19.

Jensen AR, Goldin AB, Koopmeiners JS, Stevens J, Waldhausen JH, Kim SS (2009) The association of cyclic parenteral nutrition and decreased incidence of cholestatic liver disease in patients with gastroschisis. J Pediatr Surg 44(1):183–189. https://doi.org/10.1016/j.jpedsurg.2008.10.033 CrossRefPubMed

20.

Lauriti G, Zani A, Aufieri R, Cananzi M, Chiesa PL, Eaton S, Pierro A (2014) Incidence, prevention, and treatment of parenteral nutrition-associated cholestasis and intestinal failure-associated liver disease in infants and children: a systematic review. JPEN J Parenter Enteral Nutr 38(1):70–85. https://doi.org/10.1177/0148607113496280 CrossRefPubMed

21.

Lee TC, Barshes NR, Nguyen L, Karpen SJ, Quiros-Tejeira RE, Carter BA, Goss JA (2005) Gastroschisis and biliary atresia in a neonate: uncommon presentation or common precipitant. Eur J Pediatr Surg 15(6):434–436. https://doi.org/10.1055/s-2005-872928 CrossRefPubMed

22.

Lu FT, Wu JF, Hsu HY, Ni YH, Chang MH, Chao CI, Chen HL (2014) γ-Glutamyl transpeptidase level as a screening marker among diverse etiologies of infantile intrahepatic cholestasis. J Pediatr Gastroenterol Nutr 59(6):695–701. https://doi.org/10.1097/MPG.0000000000000538 CrossRefPubMed

23.

Majd M, Reba RC, Altman RP (1981) Effect of phenobarbital on 99mTc-IDA scintigraphy in the evaluation of neonatal jaundice. Semin Nucl Med 11(3):194–204CrossRefPubMed

24.

Messing B, Pontal PJ, Bernier JJ (1983) Metabolic study during cyclic total parenteral nutrition in adult patients with and without corticosteroid-induced hypercatabolism: comparison with standard total parenteral nutrition. JPEN 7(1):21–25. https://doi.org/10.1177/014860718300700121 CrossRef

25.

Alves FMDS, Miranda ME, Aguiar MJBD, Viana MCFB (2016) Nutritional management and postoperative prognosis of newborns submitted to primary surgical repair of gastroschisis. J Pediatr (Rio J) 92(3):268–275. https://doi.org/10.1016/j.jped.2015.07.009 CrossRef

26.

Moss RL, Amii LA (1999) New approaches to understanding the etiology and treatment of total parenteral nutrition-associated cholestasis. Semin Pediatr Surg 8(3):140–147CrossRefPubMed

27.

Moyer V, Freese DK, Whitington PF, Olson AD, Brewer F, Colletti RB (2004) North American Society for Pediatric Gastroenterology, H. p. a. Guideline for the evaluation of cholestatic jaundice in infants: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 39(2):115–128 N.CrossRefPubMed

28.

Overcash RT, DeUgarte DA, Stephenson ML, Gutkin RM, Norton ME, Parmar S, Schrimmer DB (2014) Factors associated with gastroschisis outcomes. Obstet Gynecol 124(3):551–557. https://doi.org/10.1097/aog.0000000000000425 CrossRefPubMedPubMedCentral

29.

Poddar U, Bhattacharya A, Thapa BR, Mittal BR, Singh K (2004) Ursodeoxycholic acid-augmented hepatobiliary scintigraphy in the evaluation of neonatal jaundice. J Nucl Med 45(9):1488–1492PubMed

30.

Raimondi F, Indrio F, Crivaro V, Araimo G, Capasso L, Paludetto R (2008) Neonatal hyperbilirubinemia increases intestinal protein permeability and the prevalence of cow’s milk protein intolerance. Acta Paediatr 97(6):751–753. https://doi.org/10.1111/j.1651-2227.2008.00746.x CrossRefPubMed

31.

Rangel S, Calkins C, Cowles R, Barnhart D, Huang E, Abdullah F, Teitelbaum D (2012) Parenteral nutrition–associated cholestasis: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. 47(1), 225–240. https://doi.org/10.1016/j.jpedsurg.2011.10.007

32.

Salama GS, Kaabneh MA, Almasaeed MN, Alquran MI a (2015) Intravenous lipids for preterm infants: a review. Clin Med Insights Pediatr 9:25–36. https://doi.org/10.4137/CMPed.S21161 CrossRefPubMedPubMedCentral

33.

Samra NM, Abrak EE, Dash SEl, Raziky HH,ESaidE, M., & Sheikh E, M. A (2018) Evaluation of vitamin D status bone mineral density and dental health in children with cholestasis. Clin Res Hepatol Gastroenterol 42(4):368–377. https://doi.org/10.1016/j.clinre.2017.11.010 CrossRefPubMed

34.

Satrom K, Gourley G (2016) Cholestasis in Preterm Infants. Clin Perinatol 43(2):355–373. https://doi.org/10.1016/j.clp.2016.01.012 CrossRefPubMed

35.

Sax HC, Illig KA, Ryan CK, Hardy DJ (1996) Low-dose enteral feeding is beneficial during total parenteral nutrition. Am J Surg 171(6):587–590CrossRefPubMed

36.

Sloane AJ, Nawab US, Carola D, Aghai ZH (2017) Utility of measuring direct bilirubin at first 72 h of age in neonates admitted to the neonatal intensive care unit. J Perinatol 37(5):536–540. https://doi.org/10.1038/jp.2016.259 CrossRefPubMedPubMedCentral

37.

Strang BJ, Reddix BA, Wolk RA (2016) Improvement in parenteral nutrition-associated cholestasis with the use of Omegaven in an infant with short bowel syndrome. Nutr Clin Pract 31(5):647–653. https://doi.org/10.1177/0884533616643697 CrossRefPubMed

38.

Thibault M, McMahon J, Faubert G, Charbonneau J, Malo J, Ferreira E, Mohamed I (2014) Parenteral nutrition-associated liver disease: a retrospective study of ursodeoxycholic acid use in neonates. https://doi.org/10.5863/1551-6776-19.1.42

39.

Ullah S, Rahman K, Hedayati M (2016) Hyperbilirubinemia in neonates: types, causes, clinical examinations, preventive measures and treatments: a narrative review article. Iran J Public Health 45(5):558–568PubMedPubMedCentral

40.

Ziessman HA (2009) Interventions used with cholescintigraphy for the diagnosis of hepatobiliary disease. Semin Nucl Med 39(3):174–185. https://doi.org/10.1053/j.semnuclmed.2008.12.002 CrossRefPubMed

41.

İpek M, Aydın M, Zencıroğlu A, Gökçe S, Okumuş N, Gülaldı NC (2013) Conjugated hyperbilirubinemia in the neonatal intensive care unit. Turk J Gastroenterol 24(5):406–414CrossRefPubMed

Title: Direct hyperbilirubinemia in newborns with gastroschisis
Authors: Sarah B. Cairo
Alex H. Osak
Sara K. Berkelhamer
Cara McLaughlin
David H. Rothstein
Publication date: 01-03-2019
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Surgery International / Issue 3/2019
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-018-4415-1

At a glance: The STEP trials

Springer Medicine

Direct hyperbilirubinemia in newborns with gastroschisis

Abstract

Background

Objective

Design/Methods

Results

Conclusion(s)

Levels of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Objective

Design/Methods

Results

Conclusion(s)

Levels of evidence

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