Efficacy of fat-soluble vitamin supplementation in infants with biliary atresia

Benjamin L. Shneider*, John C. Magee, Jorge A. Bezerra, Barbara Haber, Saul J. Karpen, Trivellore Raghunathan, Philip Rosenthal, Kathleen Schwarz, Frederick J. Suchy, Nanda Kerkar, Yumirle Turmelle, Peter F. Whitington, Patricia R. Robuck, Ronald J. Sokol

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

55 Scopus citations

Abstract

OBJECTIVE: Cholestasis predisposes to fat-soluble vitamin (FSV) deficiencies. A liquid multiple FSV preparation made with tocopheryl polyethylene glycol-1000 succinate (TPGS) is frequently used in infants with biliary atresia (BA) because of ease of administration and presumed efficacy. In this prospective multicenter study, we assessed the prevalence of FSV deficiency in infants with BA who received this FSV/ TPGS preparation. METHODS: Infants received FSV/TPGS coadministered with additional vitamin K as routine clinical care in a randomized double-blinded, placebocontrolled trial of corticosteroid therapy after hepatoportoenterostomy (HPE) for BA (identifier NCT 00294684). Levels of FSV, retinol binding protein, total serum lipids, and total bilirubin (TB) were measured 1, 3, and 6 months after HPE. RESULTS: Ninety-two infants with BA were enrolled in this study. Biochemical evidence of FSV insufficiency was common at all time points for vitamin A (29%-36% of patients), vitamin D (21%-37%), vitamin K (10%- 22%), and vitamin E (16%-18%). Vitamin levels were inversely correlated with serum TB levels. Biochemical FSV insufficiency was much more common (15%-100% for the different vitamins) in infants whose TB was ≥2 mg/dL. At 3 and 6 months post HPE, only 3 of 24 and 0 of 23 infants, respectively, with TB >2 mg/dL were sufficient in all FSV. CONCLUSIONS: Biochemical FSV insufficiency is commonly observed in infants with BA and persistent cholestasis despite administration of a TPGS containing liquidmultiple FSV preparation. Individual vitamin supplementation and careful monitoring are warranted in infants with BA, especially those with TB >2 mg/dL.

Original languageEnglish (US)
Pages (from-to)e607-e614
JournalPediatrics
Volume130
Issue number3
DOIs
StatePublished - Sep 2012

Keywords

  • Cholestasis
  • Liver
  • Nutrition
  • Vitamin deficiency

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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