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.