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Management of neonatal cholestasis

Chad Best and Glenn R Gourley

Cholestasis is a frequent occurrence in newborns, affecting one in every 2500 infants. Immaturity of hepatic metabolic and excretory functions contributes to decreased bile production and transport. The potential causes of neonatal cholestasis are extensive, but most cases fall into a few categories, including anatomic, metabolic and infectious. Pruritus and malabsorption are common manifestations of neonatal cholestasis, regardless of etiology. Medical management of cholestasis is largely supportive, treating the complications of cholestasis rather than the underlying mechanism. Medications for pruritus have variable effi cacy and include ursodeoxycholic acid, cholestyramine and rifampin. Fat-soluble vitamin supplementation is often required secondary to fat malabsorption. Enteral absorption of long-chain triglycerides is also decreased, necessitating formulas high in medium-chain triglycerides. Infants may require 125% of the recommended daily allowance of calories for adequate growth and supplementation with enteral feeding tubes may be required.