Commercially available multivitamin preparations commonly given to infants with biliary atresia to prevent fat soluble vitamin deficiencies are ineffective, according to researchers presenting at the 2009 annual meeting of the American Association for the Study of Liver Diseases. “This study examined a multivitamin preparation, which if often used by clinicians due to the convenience and perception that it is effective, however, there are alternatives, such as giving multiple prescriptions of individual vitamins and/or intramuscular injections, said Benjamin Shneider, MD, principal investigator for this study,”
Although biliary atresia is a rare disease – occurring in one in 13,000 to 14,000 children in the USA – it is the most common indication for liver transplantation in children. The only current treatment is surgery or transplantation, and the disease occurs in infants within weeks of birth. The surgery performed on these patients is the reconstruction of the extrahepatic biliary tract connecting the liver with the small intestine. Fifty-seven infants who underwent this surgery were studied, and 40 of those 57 had vitamin deficiencies by one year of age despite the use of commercially available multivitamin preparations.
Long-term consequences of these vitamin deficiencies were not specifically analyzed in this study, but Dr. Shneider did speak to potential consequences for these patients, “Issues that can potentially arise in the first year of life include bone disease secondary to vitamin D deficiency and clotting disorder or bleeding related to vitamin K deficiency.”
The authors of this study concluded that the current multivitamin supplements are not adequate and monitoring for deficiencies and alternative methods of supplementation are needed. According to Dr. Shneider, “The Childhood Liver Disease Research and Education Network (ChiLDREN, formerly the Biliary Atresia Research Consortium), a multicentered NIH funded study group, is ideally positioned to address this issue and other matters related to the pathogenesis, prognosis and treatment of biliary atresia and other forms of cholestatic liver disease in children.”
Abstract title:
A prospective multicentered investigation of vitamin supplementation in infants with biliary atresia: Interim Analysis from the biliary atresia research consortium (BARC)
