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Parenteral Nutrition–Associated Cholestasis in Neonates: Multivariate Analysis of the Potential Protective Effect of Taurine

Ariel U. Spencer, MD^*, Sunkyung Yu, MS, Thomas F. Tracy, MD, Moustafa M. Aouthmany, MD^||, Adolfo Llanos, MD^¶, Morton B. Brown, PhD, Marilyn Brown, MD^¶, Robert J. Shulman, MD^#, Ronald B. Hirschl, MD^*, Patricia A. DeRusso, MD^**, Jean Cox, MS^**, Jacqueline Dahlgren, MS^*, Peter J. Strouse, MD, Jonathan I. Groner, MD and Daniel H. Teitelbaum, MD^*

From the Departments of ^* Surgery and Radiology and the School of Public Health, University of Michigan, and the C.S. Mott Children's Hospital, Ann Arbor, Michigan; Brown University, Providence, Rhode Island;^|| St. Vincent's Mercy Children's Hospital, Toledo, Ohio; ^¶ Strong Memorial Hospital, University of Rochester, Rochester, New York; ^# Baylor College of Medicine, Houston, Texas; ^** The Johns Hopkins University School of Medicine, Baltimore, Maryland; and Columbus Children's Hospital, Columbus, Ohio

Correspondence: Daniel H. Teitelbaum, MD, Section of Pediatric Surgery, University of Michigan Hospitals, F3970 Mott Children's Hospital, Box 0245, Ann Arbor, MI 48109. Electronic mail may be sent to dttlbm{at}umich.edu.

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.

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Journal of Parenteral and Enteral Nutrition, Vol. 29, No. 5, 337-344 (2005)
DOI: 10.1177/0148607105029005337


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