MAGANESE INTAKE AND CHOLESTATIC JAUNDICE IN NEWBORNS RECEIVING PARENTERAL NUTRITION - A RANDOMIZED CONTROLLED TRIAL

Fok TF1, Chui KKM1, Cheung R2, Ng PC1, Cheung KL1, Hjelm M2

1Department of Paediatrics, 2Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, China

 

Objective: To investigate the effect of maganese intake in parenteral nutrition on the whole-blood maganese level, serum direct bilirubin level and on the subsequent development of cholestatic jaundice in newborns.

Methodology: 244 infants of all gestation who were admitted into neonatal unit during the study period and estimated to require parenteral nutrition as more than three quarters of their daily fluid intake for over two weeks were enrolled with parental consent.  They were randomized to either receiving Ped-El of 4ml/Kg/day (Group 1, maganese intake 1 nmol/Kg/day) or peditrace of 1ml/Kd/day (Group 2, maganese intake of 0.0182 nmol/Kg/day) as their trace element supplementation.  Baseline blood test for liver function test was checked before the study and the babies had subsequent serial monitoring of blood for maganese level and liver function test at weekly intervals. 

Results: Of the 244 infants enrolled, the high maganese intake group (Group 1) showed a trend of developing higher peak whole-blood maganese level ant higher peak serum direct bilirubin concentration, but the difference between the two group did not reach statistical significance.  No difference existed in the occurrence of cholestasis during period of parenteral nutrition between the two groups. 

Subgroup analysis was carried out in data from 78 infants in group and 82 infants in group 2 who received more than three-quarters of their fluid intake as parenteral nutrition for over 2 weeks.  The high manganese intake group developed significantly higher whole-blood maganese level and serum direct bilirubin level.  No significant difference in the occurrence of cholestasis between the two groups, but more infants in the high intake developed a more severe degree of cholestatic jaundice with direct bilirubin > 100 umol/L.

Conclusion: High maganese intake is a significant contributory factor on the pathogenesis of parenteral nutrition related cholestasis.  

 
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