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Yenidoğan Bebeklerde Neonatal Kolestaz İnsidansı ve Etiyolojisi

Yıl 2021, Cilt: 7 Sayı: 1, 143 - 154, 01.01.2021

Öz

Amaç: Yenidoğan yoğun bakım ünitesinde yatan bebeklerde kolestaz sıklığının, karakteristik özelliklerinin, etiyolojilerinin, klinik ve laboratuvar verileri eşliğinde değerlendirilmesi amaçlandı.Gereç ve Yöntemler: Tek merkezli, retrospektif, 2016-2020 yıllarını kapsayan kohort çalışmaya direkt bilirubin değeri >2 mg/dl ya da total bilirubin seviyesi >5 mg/dl iken direkt bilirubin değerinin total bilirubinin >%20 olan yenidoğanlar alındı. Hastaların perinatal özellikleri, başvuru şikayetleri, klinik, laboratuvar verileri kaydedildi. Kolestaz nedenleri metabolik-genetik, sendromik, bilier, nutrisyonel, kardiyovasküler, enfeksiyon, endokrin ve sebebi açıklanamayan nedenler olarak gruplandırıldı. İstatistiksel değerlendirme üç temel grupta metabolik-genetik, parenteral-nutrisyonilişkili, diğerleri yapıldı. Bulgular: Neonatal kolestaz sıklığı 8,5/1000 yenidoğan olarak saptandı. En sık nedenleri parenteral nutrisyon %36,4 ile metabolik-genetik hastalıklar %32,7 oluşturdu. Çalışmaya alınan hastaların %76,4’ünü preterm-yenidoğanlar oluştururken, parenteral-nutrisyon grubundaki pretermler, gestasyon yaşı açısından en düşük hafta, doğum kilosu açısından ise en düşük doğum ağırlığına sahipti üç grup arasında sırasıyla p

Kaynakça

  • Magyar MA, Metropulos D, Antoon JW. Direct Hyperbi- lirubinemia in an Infant. Clin Pediatr 2017; 56:696-9.
  • Cairo SB, Osak AH, Berkelhamer SK, McLaughlin C, Rothstein DH. Direct hyperbilirubinemia in newborns with gastroschisis. Pediatr Surg Int 2019; 35:293-301.
  • Fawaz R, Baumann U, Ekong U, Fischler B, Hadzic N, Mack CL, Karpen SJ. Guideline for the evaluation of cholestatic jaundice in infants: Joint recommendations of the North American Society for pediatric gastroentero- logy, hepatology, and nutrition and the european society for pediatric gastroenterology, hepatology, and nutrition. J Pediatr Gastroenterol Nutr 2017; 64:154-68.
  • Bıçakcıoğlu I, Özdemir R, Turgut H, Gökçe İK, Seli- moğlu MA. Neonatal kolestaz: 94 olgunun geriye dönük incelenmesi. Çocuk Sağlığı ve Hastalıkları Dergisi 2017; 60:129-38.
  • DaniC, PratesiS, RaimondiF, RomagnoliC. Task Force for Hyperbilirubinemia of the Italian Society of Neonato- logy. Italian guidelines for the management and treatment of neonatal cholestasis. Ital J Pediatr 2015; 41:69.
  • Lauriti G, Zani A, Aufieri R, Cananzi M, Chiesa PL, Eaton S, Pierro A. Incidence, prevention, and treatment of parenteral nutrition-associated cholestasis and intesti- nal failure-associated liver disease in infants and children: a systematic review. JPEN J Parenter Enteral Nutr 2014; 38:70-85.
  • İpek M, Aydın M, Zenciroğlu A, Gökçe S, Okumuş N, Gülaldı NC. Conjugated hyperbilirubinemia in the neonatal intensive care unit. Turk J Gastroenterol 2013; 24:406-14.
  • Satrom K, Gourley G. Cholestasis in preterm infants. Clin Perinatol 2016; 43:355-73.
  • Lane E, Murray KF. Neonatal Cholestasis. Pediatr Clin North Am 2017; 64:621-39.
  • Sarı S, Eğritaş Ö, Barış Z, Ünlüsoy A, Bükülmez A, Dalgıç B. Bebeklik çağı kolestatik karaciğer hastalıkları: 190 olgu- nun geriye dönük değerlendirilmesi. Türk Pediatri Arşivi 2012; 47:167-73.
  • TufanoM, Nicastro E, Giliberti P, Vegnente A, Raimondi F, Lorio R. Cholestasis in neonatal intensive care unit: Incidence, aetiology and management. Acta Paediatr 2009; 98:1756-61.
  • Çoban A, Türkmen M, Gürsoy T. Türk Neonatoloji Derneği yenidoğan sarılıklarında yaklaşım, izlem ve tedavi rehberi 2014, (https://www.neonatology.org.tr/ storage/2020/04/Sarilik.pdf).
  • Lee WS, Sokol RJ. Intestinal microbiota, lipids, and the pathogenesis of intestinal failure-associated liver disease. J Pediatr 2015; 167:519-26.
  • Bove KE, Heubi JE, Balistreri WF, Setchell KD. Bile acid synthetic defects and liver disease: A comprehensive review. Pediatr Dev Pathol 2004; 7:315-34.
  • Philip J, Samraj RS, Lopez-Colon D, Gonzalez-Peralta R, Chandran A, Bleiwies MS. Severe direct hyperbilirubi- nemia as a consequence of right heart failure in congenital heart disease. World J Pediatr Congenit Heart Surg 2018; 9:470-4.
  • Pierro A. Incidence, prevention, and treatment of paren- teral nutrition-associated cholestasis and intestinal failure- associated liver disease in infants and children: A systema- tic review. JPEN J Parenter Enteral Nutr 2014; 38:70-85.
  • Sloane AJ, Nawab US, Carola D, Aghai Z. Utility of measuring direct bilirubin at first 72 h of age in neonates admitted to the neonatal intensive care unit. J Perinatol 2017; 37:536-40.
  • Iwatani S, Kataoka D, Tamaki S, Yokota T, Yoshimoto S. High prevalence of cholestasis at a tertiary neonatal intensive care unit. Pediatr Int 2020; 62:749-51.
  • Chiou FK, Ong C, Phua KB, Chedid F, l Kader A. Conju- gated hyperbilirubinemia presenting in first fourteen days in term neonates. World Hepatol 2017; 26:1108-14.
  • Rangel SJ, Calkins CM, Cowles RA, Barnhart DC, Huang EY, Abdullah F, Arca MJ, Teitelbaum DH, 2011 American Pediatric Surgical Association Outcomes and Clinical Trials Committee. Parenteral nutrition-associa- ted cholestasis: an American Pediatric Surgical Associa- tion Outcomes and Clinical Trials Committee Systematic review. J Pediatr Surg 2012; 47:225-40.
  • El Kasmi KC, Anderson AL, Devereaux MW, Vue PM, Zhang W, Setchell KDR, Karpen SJ, Sokol RJ. Phytos- terols promote liver injury and Kupffer cell activation in parenteral nutrition-associated liver disease. Sci Transl Med 2013; 5:206ra137.
  • Irk T, Soylu ÖB, Çalkavur Ş, Olukman Ö, Çelik K. Yenidoğan döneminde direkt hiperbilirubinemi saptanan olguların değerlendirilmesi. İzmir Dr. Behçet Uz Çocuk Hast Dergisi 2020; 10:143-9.
  • Çetin H, Akdeniz S, Olgar Ş, Öktem F, Dündar B, Ayata A. Çok düşük doğum ağırlıklı bebeklerde total parenteral beslenme ilişkili kolestaz ve ursodeoksikolik asit tedavisi- nin etkinliği. SDÜ Tıp Fakültesi Dergisi 2006; 13:7-11.
  • Beale EF, Nelson RM, Bucciarelli RL, Donnelly WH, Eitzman DV. Intra-hepatic cholestasis associated associ- ated with parenteral-nutrition in premature-infants. Pedi- atrics 1979; 64:342-7.
  • Klein CJ, Ravenis M, Kusenda C, Scavo L. Parenteral nutrition-associated conjugated hyperbilirubinemia in infants. J Am Diet Assoc 2010; 110:1684-95.
  • Żalikowska-Gardocka M, Adam Przybyłkowski A. Review of parenteral nutrition-associated liver disease. Clin Expl Hepatol 2020; 6:65-73.
  • Squires JE, Heubi JE. Metabolic liver disease: Part 1. In: Murray KF, Horslen S, eds. Diseases of the liver in child- ren, 1st ed. New York, Springer; 2014:153-83.
  • Tiker F, Tarcan A, Kilicdag H, Gurakan B. Early onset conjugated hyperbilirubinemia in newborn infants. Indian J Pediatr 2006; 73:409-12.
  • Gottesman LE, Del Vecchio MT, Aronoff SC. Etiologies of conjugated hyperbilirubinemia in infancy: A systematic review of 1692 subjects. BMC Pediatrics 2015; 15:192- 200.
  • Kelly DA. Preventing parenteral nutrition liver disease. Early Hum Dev 2010; 86:683-7.

The Incidence and Etiology of Neonatal Cholestasis in Newborn Infants

Yıl 2021, Cilt: 7 Sayı: 1, 143 - 154, 01.01.2021

Öz

Objective: To evaluate the incidence, characteristic features, etiologies, and the clinical and laboratory outcome of neonatal cholestasis at the neonatal intensive care unit.Material and Methods: All newborns with direct bilirubin levels >2 mg/dl or 20% of total bilirubin when total bilirubin was >5 mg/dl were enrolled in this retrospective, single-center, cohort study. The perinatal characteristics, initial complaints, clinical and laboratory features were extracted. The etiology of cholestasis was recorded as metabolic-genetic conditions, syndromic, biliary, nutritional, cardiovascular, infectious, endocrine conditions and unknown origin. Statistical analyses were performed on three main group categories metabolic-genetic conditions, parenteral-nutritionassociated, and others .Results: The cholestasis incidence was 8.5/1000 live births. Parenteral-nutrition 36.4% and metabolic-genetic conditions 32.7% constituted the most common etiologies. The study population had a 76.4% rate of preterm delivery. Infants in theparenteral-nutrition group demonstrated earlier gestation p

Kaynakça

  • Magyar MA, Metropulos D, Antoon JW. Direct Hyperbi- lirubinemia in an Infant. Clin Pediatr 2017; 56:696-9.
  • Cairo SB, Osak AH, Berkelhamer SK, McLaughlin C, Rothstein DH. Direct hyperbilirubinemia in newborns with gastroschisis. Pediatr Surg Int 2019; 35:293-301.
  • Fawaz R, Baumann U, Ekong U, Fischler B, Hadzic N, Mack CL, Karpen SJ. Guideline for the evaluation of cholestatic jaundice in infants: Joint recommendations of the North American Society for pediatric gastroentero- logy, hepatology, and nutrition and the european society for pediatric gastroenterology, hepatology, and nutrition. J Pediatr Gastroenterol Nutr 2017; 64:154-68.
  • Bıçakcıoğlu I, Özdemir R, Turgut H, Gökçe İK, Seli- moğlu MA. Neonatal kolestaz: 94 olgunun geriye dönük incelenmesi. Çocuk Sağlığı ve Hastalıkları Dergisi 2017; 60:129-38.
  • DaniC, PratesiS, RaimondiF, RomagnoliC. Task Force for Hyperbilirubinemia of the Italian Society of Neonato- logy. Italian guidelines for the management and treatment of neonatal cholestasis. Ital J Pediatr 2015; 41:69.
  • Lauriti G, Zani A, Aufieri R, Cananzi M, Chiesa PL, Eaton S, Pierro A. Incidence, prevention, and treatment of parenteral nutrition-associated cholestasis and intesti- nal failure-associated liver disease in infants and children: a systematic review. JPEN J Parenter Enteral Nutr 2014; 38:70-85.
  • İpek M, Aydın M, Zenciroğlu A, Gökçe S, Okumuş N, Gülaldı NC. Conjugated hyperbilirubinemia in the neonatal intensive care unit. Turk J Gastroenterol 2013; 24:406-14.
  • Satrom K, Gourley G. Cholestasis in preterm infants. Clin Perinatol 2016; 43:355-73.
  • Lane E, Murray KF. Neonatal Cholestasis. Pediatr Clin North Am 2017; 64:621-39.
  • Sarı S, Eğritaş Ö, Barış Z, Ünlüsoy A, Bükülmez A, Dalgıç B. Bebeklik çağı kolestatik karaciğer hastalıkları: 190 olgu- nun geriye dönük değerlendirilmesi. Türk Pediatri Arşivi 2012; 47:167-73.
  • TufanoM, Nicastro E, Giliberti P, Vegnente A, Raimondi F, Lorio R. Cholestasis in neonatal intensive care unit: Incidence, aetiology and management. Acta Paediatr 2009; 98:1756-61.
  • Çoban A, Türkmen M, Gürsoy T. Türk Neonatoloji Derneği yenidoğan sarılıklarında yaklaşım, izlem ve tedavi rehberi 2014, (https://www.neonatology.org.tr/ storage/2020/04/Sarilik.pdf).
  • Lee WS, Sokol RJ. Intestinal microbiota, lipids, and the pathogenesis of intestinal failure-associated liver disease. J Pediatr 2015; 167:519-26.
  • Bove KE, Heubi JE, Balistreri WF, Setchell KD. Bile acid synthetic defects and liver disease: A comprehensive review. Pediatr Dev Pathol 2004; 7:315-34.
  • Philip J, Samraj RS, Lopez-Colon D, Gonzalez-Peralta R, Chandran A, Bleiwies MS. Severe direct hyperbilirubi- nemia as a consequence of right heart failure in congenital heart disease. World J Pediatr Congenit Heart Surg 2018; 9:470-4.
  • Pierro A. Incidence, prevention, and treatment of paren- teral nutrition-associated cholestasis and intestinal failure- associated liver disease in infants and children: A systema- tic review. JPEN J Parenter Enteral Nutr 2014; 38:70-85.
  • Sloane AJ, Nawab US, Carola D, Aghai Z. Utility of measuring direct bilirubin at first 72 h of age in neonates admitted to the neonatal intensive care unit. J Perinatol 2017; 37:536-40.
  • Iwatani S, Kataoka D, Tamaki S, Yokota T, Yoshimoto S. High prevalence of cholestasis at a tertiary neonatal intensive care unit. Pediatr Int 2020; 62:749-51.
  • Chiou FK, Ong C, Phua KB, Chedid F, l Kader A. Conju- gated hyperbilirubinemia presenting in first fourteen days in term neonates. World Hepatol 2017; 26:1108-14.
  • Rangel SJ, Calkins CM, Cowles RA, Barnhart DC, Huang EY, Abdullah F, Arca MJ, Teitelbaum DH, 2011 American Pediatric Surgical Association Outcomes and Clinical Trials Committee. Parenteral nutrition-associa- ted cholestasis: an American Pediatric Surgical Associa- tion Outcomes and Clinical Trials Committee Systematic review. J Pediatr Surg 2012; 47:225-40.
  • El Kasmi KC, Anderson AL, Devereaux MW, Vue PM, Zhang W, Setchell KDR, Karpen SJ, Sokol RJ. Phytos- terols promote liver injury and Kupffer cell activation in parenteral nutrition-associated liver disease. Sci Transl Med 2013; 5:206ra137.
  • Irk T, Soylu ÖB, Çalkavur Ş, Olukman Ö, Çelik K. Yenidoğan döneminde direkt hiperbilirubinemi saptanan olguların değerlendirilmesi. İzmir Dr. Behçet Uz Çocuk Hast Dergisi 2020; 10:143-9.
  • Çetin H, Akdeniz S, Olgar Ş, Öktem F, Dündar B, Ayata A. Çok düşük doğum ağırlıklı bebeklerde total parenteral beslenme ilişkili kolestaz ve ursodeoksikolik asit tedavisi- nin etkinliği. SDÜ Tıp Fakültesi Dergisi 2006; 13:7-11.
  • Beale EF, Nelson RM, Bucciarelli RL, Donnelly WH, Eitzman DV. Intra-hepatic cholestasis associated associ- ated with parenteral-nutrition in premature-infants. Pedi- atrics 1979; 64:342-7.
  • Klein CJ, Ravenis M, Kusenda C, Scavo L. Parenteral nutrition-associated conjugated hyperbilirubinemia in infants. J Am Diet Assoc 2010; 110:1684-95.
  • Żalikowska-Gardocka M, Adam Przybyłkowski A. Review of parenteral nutrition-associated liver disease. Clin Expl Hepatol 2020; 6:65-73.
  • Squires JE, Heubi JE. Metabolic liver disease: Part 1. In: Murray KF, Horslen S, eds. Diseases of the liver in child- ren, 1st ed. New York, Springer; 2014:153-83.
  • Tiker F, Tarcan A, Kilicdag H, Gurakan B. Early onset conjugated hyperbilirubinemia in newborn infants. Indian J Pediatr 2006; 73:409-12.
  • Gottesman LE, Del Vecchio MT, Aronoff SC. Etiologies of conjugated hyperbilirubinemia in infancy: A systematic review of 1692 subjects. BMC Pediatrics 2015; 15:192- 200.
  • Kelly DA. Preventing parenteral nutrition liver disease. Early Hum Dev 2010; 86:683-7.
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Araştırma Makalesi
Yazarlar

Hakan Ongun Bu kişi benim

İpek Acarbulut Bu kişi benim

Celal Sağlam Bu kişi benim

Zeynep Kıhtır Bu kişi benim

Kıymet Çelik Bu kişi benim

Nihal Oygür Bu kişi benim

Yayımlanma Tarihi 1 Ocak 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 7 Sayı: 1

Kaynak Göster

APA Ongun, H., Acarbulut, İ., Sağlam, C., Kıhtır, Z., vd. (2021). Yenidoğan Bebeklerde Neonatal Kolestaz İnsidansı ve Etiyolojisi. Akdeniz Tıp Dergisi, 7(1), 143-154.