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Published on: November 20, 2015
[Risk factors for parenteral nutrition-associated cholestasis in preterm infants]
1Department of Pediatrics, Peking University Third Hospital, Beijing, China.
Insights
Parenteral nutrition-associated cholestasis (PNAC) in preterm infants is linked to longer PN duration, higher nutrient intake, low birth weight, and infections. Identifying these risk factors is crucial for infant health.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Nutritional Science
Context:
- Parenteral nutrition (PN) is essential for preterm infants unable to feed enterally.
- Parenteral nutrition-associated cholestasis (PNAC) is a significant complication in this vulnerable population.
- Understanding PNAC risk factors is critical for optimizing infant outcomes.
Purpose:
- To identify key risk factors associated with the development of PNAC in preterm infants.
- To analyze the relationship between PN delivery parameters and PNAC incidence.
- To provide data for the prevention and management of PNAC.
Summary:
- A case-control study of 244 preterm infants revealed that longer PN duration, higher total and maximum daily amino acid and lipid intake, increased day 14 intravenous calorie intake, low birth weight, neonatal infection, and anemia were significantly associated with PNAC.
- Infants without PNAC showed different associations between nutrient intake, PN duration, mechanical ventilation, and gestational age, highlighting complex interactions.
- These findings underscore the multifactorial nature of PNAC in preterm neonates.
Impact:
- Informs clinical practice regarding PN management in preterm infants to mitigate PNAC risk.
- Highlights the need for careful monitoring of nutritional intake and clinical status in infants receiving prolonged PN.
- Suggests areas for future research into novel preventative strategies for PNAC.
Objective:
To investigate risk factors for parenteral nutrition-associated cholestasis (PNAC) in preterm infants.
Methods:
A retrospective case-control study was performed on 244 preterm infants who received parenteral nutrition (PN) for over 14 days from January 2000 to October 2011.
Results:
Compared with those without PNAC (n=221), preterm infants with PNAC (n=23) had a longer total duration of PN, a higher total amino acid intake, a higher total lipid intake, a higher maximum daily amino acid intake, a higher maximum daily lipid intake, a higher intravenous calorie intake on the 14th day of PN, a lower birth weight and higher incidence rates of neonatal infection and anemia. Compared with those with PNAC, preterm infants without PNAC who showed a higher total amino acid intake also had a higher total lipid intake, a longer total duration of PN, a higher rate of mechanical ventilation and a lower gestational age. The preterm infants without PNAC who showed a higher total lipid intake also had a lower gestational age. Preterm infants without PNAC who showed a longer total duration of PN also had a lower gestational age.
Conclusions:
Total duration of PN, total amino acid intake, maximum daily amino acid intake, total lipid intake, maximum daily lipid intake, intravenous calorie intake on the 14th day of PN, low birth weight, and neonatal infection and anemia are the risk factors for PNAC. Other risk factors need further investigation.
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