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Total parenteral nutrition-associated cholestasis and risk factors in preterm infants
Turki M Alkharfy1, Rubana Ba-Abbad, Anjum Hadi
1Department of Pediatrics, College of Medicinal and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
Insights
Lower birth weight and longer duration of total parenteral nutrition are key predictors of cholestasis in preterm infants. This study identifies critical risk factors for this common complication.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Hepatic dysfunction is a known complication of total parenteral nutrition (TPN) in preterm infants.
- While TPN-associated cholestasis incidence and contributing factors are documented, predictive risk factors require further investigation.
- This study aimed to determine the incidence of TPN-associated cholestasis and develop a predictive model.
Purpose of the Study:
- To ascertain the incidence of TPN-associated cholestasis in very low birth weight infants.
- To identify and validate predictive risk factors for TPN-associated cholestasis.
- To develop a predictive model for cholestasis in this vulnerable population.
Main Methods:
- Retrospective review of medical records for very low birth weight infants (January 2001-December 2003).
- Infants classified as cholestasis (>34 μmol/L direct serum bilirubin) or non-cholestasis.
- Multivariate logistic regression and ROC curve analysis to identify and assess risk factors.
Main Results:
- The incidence of cholestasis was 24.1% (74/307 infants).
- Lower birth weight (735.4 ± 166.4 g) and shorter gestational age (25.4 ± 2.1 weeks) were significantly associated with cholestasis (P < 0.001).
- Significant predictors included birth weight (OR 0.99) and TPN duration (OR 1.18), with high sensitivity and specificity.
Conclusions:
- Lower birth weight is a significant risk factor for TPN-associated cholestasis.
- Extended duration of total parenteral nutrition strongly predicts cholestasis development.
- These factors can inform early identification and management strategies for TPN-associated cholestasis.
Background/Aim:
Development of hepatic dysfunction is a well-recognized complication of total parenteral nutrition in preterm infants. Previous studies reported the incidence of total parenteral nutrition-associated cholestasis and described possible contributing factors to its pathogenesis, but little is done trying to determine its possible predictive risk factors. The aims of this study was to determine the incidence of total parenteral nutrition-associated cholestasis and to develop a possible predictive model for its occurrence.
Patients And Methods:
A review of medical records of all very low birth weight infants admitted to neonatal intensive care unit at King Khalid University Hospital, Riyadh, Saudi Arabia, between January 2001 and December 2003 was carried out. The infants were divided into two groups: Cholestasis and noncholestasis, based on direct serum bilirubin level >34 μmol/L. A multivariate logistic regression analysis was performed to calculate the statistical significance of risk factors. Receiver-operating characteristic curve was used to determine the optimal cutoff points for the significant risk factors and to calculate their sensitivity and specificity. The level of significance was set at P ≤ 0.05.
Results:
A total of 307 patients were included in the analysis. The incidence of cholestasis in the whole population was 24.1% (74 patients). Infants with cholestasis had a lower birth weight, 735.4 ± 166.4 g vs. 1185.0 ± 205.6 g for noncholestasis group (P < 0.001), whereas the mean gestational age for the two groups was 25.4 ± 2.1 week and 28.9 ± 2.1 week, respectively (P < 0.001). The significant risk factors for the development of cholestasis were birth weight (P = 0.006) with an odds ratio of 0.99 [95% confidence interval (CI), 0.98, 0.99]; sensitivity of 92%, specificity of 87%; and total parenteral nutrition duration (P < 0.001) with an odds ratio of 1.18 (95% CI, 1.10, 1.27); sensitivity of 96%, specificity of 89%.
Conclusions:
A lower birth weight and longer duration of total parenteral nutrition were strong predictive risk factors for the development of cholestasis in preterm infants.
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