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Published on: September 20, 2019
Analysis of risk factors for parenteral nutrition-associated cholestasis in preterm infants: a multicenter
Ya-Sen Wang1,2,3, Wei Shen1,2,3, Qing Yang1,2,3
1Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen university, Xiamen, 361003, China.
Insights
Parenteral nutrition-associated cholestasis (PNAC) in preterm infants is linked to higher amino acid doses, feeding intolerance, and necrotizing enterocolitis. Optimizing nutrition and reducing GI issues can help prevent PNAC.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Parenteral nutrition-associated cholestasis (PNAC) is a significant concern in preterm infants, but its exact causes and development are not fully understood.
- Existing research on PNAC risk factors often involves small, single-center studies, limiting generalizability.
Purpose of the Study:
- To identify and analyze the risk factors associated with the development of PNAC in preterm infants within China.
- To evaluate the role of specific nutritional components and clinical factors in PNAC development.
Main Methods:
- A retrospective multicenter observational study analyzed data from 465 very preterm or very low birth weight infants.
- Infants were categorized into PNAC and non-PNAC groups for comparative analysis.
- Logistic regression identified independent risk and protective factors for PNAC.
Main Results:
- Infants in the PNAC group exhibited lower gestational age, birth weight, and longer durations of mechanical ventilation and hospital stay.
- Higher incidences of respiratory distress syndrome, necrotizing enterocolitis (NEC), late-onset sepsis, and extrauterine growth retardation (EUGR) were observed in the PNAC group.
- Independent risk factors for PNAC included higher maximum amino acid dose, EUGR, feeding intolerance, surgically treated NEC, and longer hospital stay. Soybean oil-medium chain triglycerides-olive oil-fish oil (SMOF) and breastfeeding were protective.
Conclusions:
- Optimizing enteral and parenteral nutrition management is crucial for reducing PNAC incidence in preterm infants.
- Addressing gastrointestinal comorbidities, such as feeding intolerance and NEC, is essential for PNAC prevention.
- Promoting breastfeeding and utilizing specific lipid emulsions like SMOF may offer protective benefits against PNAC.
Background:
It is proposed that the development of parenteral nutrition-associated cholestasis (PNAC) was significantly associated with preterm birth, low birth weight, infection, etc.; however, the etiology and pathogenesis of PNAC are not fully understood. Most of the studies examining PNAC-associated risk factors were single-center studies with relatively small sample sizes.
Objective:
To analyze the risk factors associated with PNAC in preterm infants in China.
Methods:
This is a retrospective multicenter observational study. Clinical data on the effect of multiple oil-fat emulsions (soybean oil-medium chain triglycerides-olive oil-fish oil, SMOF) in preterm infants were collected from a prospective multicenter randomized controlled study. A secondary analysis was performed in which preterm infants were divided into the PNAC group and the non-PNAC group based on the PNAC status.
Results:
A total of 465 cases very preterm infants or very low birth weight infants were included in the study in which 81 cases were assigned to the PNAC group and 384 cases were assigned to the non-PNAC group. The PNAC group had a lower mean gestational age, lower mean birth weight, longer duration of invasive and non-invasive mechanical ventilation, a longer duration oxygen support, and longer hospital stay (P < 0.001 for all). The PNAC group had higher respiratory distress syndrome, hemodynamically significant patent ductus arteriosus, necrotizing enterocolitis (NEC) with stage II or higher, surgically treated NEC, late-onset sepsis, metabolic bone disease, and extrauterine growth retardation (EUGR) compared to the non-PNAC group (P < 0.05 for all). In contrast with the non-PNAC group, the PNAC group received a higher maximum dose of amino acids and fat emulsion, more medium/long-chain fatty emulsion, less SMOF, had a longer duration of parenteral nutrition, lower rates of breastfeeding, higher incidence of feeding intolerance (FI), more accumulated days to achieve total enteral nutrition, less accumulated days of total calories up to standard 110 kcal/kg/day and slower velocity of weight growth (P < 0.05 for all). Logistic regression analysis indicated that the maximum dose of amino acids (OR, 5.352; 95% CI, 2.355 to 12.161), EUGR (OR, 2.396; 95% CI, 1.255 to 4.572), FI (OR, 2.581; 95% CI, 1.395 to 4.775), surgically treated NEC (OR, 11.300; 95% CI, 2.127 ~ 60.035), and longer total hospital stay (OR, 1.030; 95% CI, 1.014 to 1.046) were independent risk factors for the development of PNAC. SMOF (OR, 0.358; 95% CI, 0.193 to 0.663) and breastfeeding (OR, 0.297; 95% CI, 0.157 to 0.559) were protective factors for PNAC.
Conclusions:
PNAC can be reduced by optimizing the management of enteral and parenteral nutrition and reducing gastrointestinal comorbidities in preterm infants.
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