Pediatr Gastroenterol Hepatol Nutr.  2016 Mar;19(1):61-70. 10.5223/pghn.2016.19.1.61.

Parenteral Nutrition-Associated Cholestasis in Very Low Birth Weight Infants: A Single Center Experience

• Kim AY
• Lim RK
• Han YM
• Park KH
• Byun SY

• KMID: 2160477
• DOI: http://doi.org/10.5223/pghn.2016.19.1.61

Abstract

PURPOSE
Parenteral nutrition (PN)-associated cholestasis (PNAC) is one of the most common complications in very low birth weight infants (VLBWIs). The aim of this study is to evaluate the risk factors of PNAC in VBLWIs.
METHODS
We retrospectively reviewed the medical records of 322 VLBWIs admitted to the neonatal intensive care unit of our hospital from July 1, 2009 to December 31, 2013. We excluded 72 dead infants; 6 infants were transferred to another hospital, and 57 infants were transferred to our hospital at 2 weeks after birth. The infants were divided into the cholestasis and the non-cholestasis groups. PNAC was defined as a direct bilirubin level of ≥2.0 mg/dL in infants administered with PN for ≥2 weeks.
RESULTS
A total of 187 VLBWI were enrolled in this study; of these, 46 infants developed PNAC. Multivariate logistic regression analysis showed that the risk factors of PNAC in VLBWI were longer duration of antimicrobial use (odds ratio [OR] 4.49, 95% confidence interval [95% CI] 4.42-4.58), longer duration of PN (OR 2.68, 95% CI 2.41-3.00), long-term lack of enteral nutrition (OR 2.89, 95% CI 2.43-3.37), occurrence of necrotizing enterocolitis (OR 2.40, 95% CI 2.16-2.83), and gastrointestinal operation (OR 2.19, 95% CI 2.03-2.58).
CONCLUSION
The results of this study suggest that shorter PN, aggressive enteral nutrition, and appropriate antimicrobial use are important strategies in preventing PNAC.

Keyword

Parenteral nutrition; Cholestasis; Very low birth weight infant

MeSH Terms

Bilirubin
Cholestasis*
Enteral Nutrition
Enterocolitis, Necrotizing
Humans
Infant*
Infant, Newborn
Infant, Very Low Birth Weight*
Intensive Care, Neonatal
Logistic Models
Medical Records
Parenteral Nutrition
Parturition
Retrospective Studies
Risk Factors
Bilirubin

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