Trends of INR and Fecal Excretion of Vitamin K During Cholestasis Reversal: Implications in the Treatment of Neonates With Intestinal Failure-Associated Liver Disease.

Autor: Dao DT; Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA., Anez-Bustillos L; Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA., Finkelstein AM; Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA., Mitchell PD; Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA., O'Loughlin AA; Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA., Fell GL; Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA., Baker MA; Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA., Potemkin AK; Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA., Gura KM; Department of Pharmacy, Boston Children's Hospital, Boston, Massachusetts, USA., Puder M; Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: JPEN. Journal of parenteral and enteral nutrition [JPEN J Parenter Enteral Nutr] 2020 Jul; Vol. 44 (5), pp. 951-958. Date of Electronic Publication: 2019 Jul 07.
DOI: 10.1002/jpen.1677
Abstrakt: Background: Vitamin K is a fat-soluble compound that plays important roles in coagulation. In children with intestinal failure-associated liver disease (IFALD), the disrupted enterohepatic circulation can lead to intestinal loss of vitamin K. Fish oil-based lipid emulsion (FOLE) has proven effective in treating IFALD. As biliary excretion is restored during cholestasis reversal, the accelerated vitamin K loss can pose a risk for deficiency.
Methods: Ten neonates with IFALD and receiving FOLE monotherapy were prospectively enrolled in the study from 2016 to 2018. In addition to weekly measurements of international normalized ratio (INR) and direct bilirubin (DB), ostomy output was collected for determination of fecal concentrations of phylloquinone (PK). Trends of DB, INR, and fecal PK concentrations were summarized with locally estimated scatterplot smoothing.
Results: The median time (interquartile range) from FOLE initiation to cholestasis reversal was 59 (19-78) days. During cholestasis reversal, INR remained relatively unchanged, whereas the mean (95% confidence interval) daily fecal excretion of PK increased from 25.1 (5.0-158.5) ng at the time of FOLE initiation to 158.5 (31.6-1000.0) ng at complete reversal. Examination of individual trends in fecal PK excretion and INR revealed little correlation between the 2 measurements (r = -0.10; P = 0.50).
Conclusion: Children with IFALD are at risk for vitamin K deficiency during cholestasis reversal. Close monitoring and quantified supplementation of vitamin K may be warranted during this period. However, this should not be guided by INR alone, as it is a poor indicator of vitamin K status.
(© 2019 American Society for Parenteral and Enteral Nutrition.)
Databáze: MEDLINE
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