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Published on: September 20, 2019
Risk factor analysis of parenteral nutrition-associated cholestasis in extremely low birth weight infants
Hyon Hui Lee1, Ji Mi Jung1, So-Hyun Nam2
1Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Pusan, Korea.
Insights
Parenteral nutrition-associated cholestasis (PNAC) affects 36% of extremely low birth weight infants, with risk factors including sepsis and prolonged PN. PNAC increases mortality risk but fish oil-based lipid preparations showed no protective effect.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Parenteral nutrition (PN) is crucial for preterm infants unable to tolerate enteral feeding.
- Prolonged PN use elevates the risk of parenteral nutrition-associated cholestasis (PNAC).
Purpose of the Study:
- To determine the incidence of PNAC in extremely low birth weight (ELBW) infants.
- To identify independent risk factors associated with PNAC development in ELBW infants.
Main Methods:
- Retrospective review of medical records for ELBW infants (March 2010 - April 2015).
- PNAC diagnosis criteria: ≥2 weeks of PN and direct bilirubin >2 mg/dL, excluding other causes.
Main Results:
- 41% of 114 ELBW infants developed PNAC.
- Independent risk factors identified: lower birth weight, sepsis, necrotizing enterocolitis, fluconazole prophylaxis, and longer PN/hospitalization duration.
- Parenteral fish oil-based lipid preparation (FOLP) did not reduce PNAC risk.
- PNAC was linked to increased mortality risk.
Conclusions:
- PNAC is prevalent in ELBW infants and associated with multiple clinical factors.
- PNAC is an independent risk factor for increased mortality in ELBW infants.
- FOLP did not demonstrate a protective effect against PNAC in this cohort.
Aim:
Parenteral nutrition (PN) provides an alternative nutrition source for preterm infants who are intolerant of enteral nutrition. However, prolonged PN increases the risk of PN-associated cholestasis (PNAC). We conducted this study to determine the incidence and risk factors of PNAC in extremely low birth weight (ELBW) infants.
Methods:
We retrospectively reviewed the medical records of ELBW infants from March 2010 to April 2015. PNAC was diagnosed in infants with a history of PN for at least two weeks and direct bilirubin concentrations >2 mg/dL after other causes of neonatal cholestasis were excluded.
Results:
Of the 114 eligible ELBW infants, 41 (36%) were diagnosed with PNAC. The multivariate analysis showed that birth weight, sepsis, necrotising enterocolitis, fluconazole prophylaxis and the duration of PN and hospitalisation were independent risk factors for the development of PNAC (p < 0.05). However, parenteral fish oil-based lipid preparation (FOLP) did not reduce the risk of PNAC. Although PNAC was not a direct cause of death, it was associated with an increased risk of mortality.
Conclusion:
PNAC was common in ELBW infants, was associated with various clinical factors and increased the risk of mortality. However, we did not observe the protective effect of FOLP against PNAC.
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