Pediatrics & Neonatology
Volume 50, Issue 5 , Pages 202-207, October 2009

Parenteral Nutrition-associated Cholestasis in Premature Babies: Risk Factors and Predictors

  • Meng-Han Hsieh

      Affiliations

    • Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
    • ,
  • Wei Pai

      Affiliations

    • Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
    • ,
  • Hsing-I Tseng

      Affiliations

    • Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • San-Nan Yang

      Affiliations

    • Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Chu-Chong Lu

      Affiliations

    • Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Hsiu-Lin Chen

      Affiliations

    • Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Corresponding Author InformationCorresponding author. Department of Pediatrics, Kaohsiung Medical University Hospital, No. 100, Shihchuan 1st Road., Sanmin District, Kaohsiung City 807, Taiwan, ROC

Received 9 July 2008; received in revised form 25 December 2008; accepted 15 January 2009.

Article Outline

Background

One of the most common complications in infants under parenteral nutrition treatment is parenteral nutrition-associated cholestasis (PNAC). The etiology of PNAC is thought to be multifactorial. The aims of this study were to evaluate the risk factors for PNAC in our neonatal intensive care unit and determine useful predictors.

Methods

This study enrolled premature infants (gestational age < 36 weeks) who were admitted to our neonatal intensive care unit and treated with parenteral nutrition infusion for at least 2 weeks between January 2004 and January 2007. Multiple possible risk factors were analyzed by a retrospective review study design. PNAC was defined as direct bilirubin greater than 1.5 mg/dL during parenteral nutrition.

Results

A total of 62 premature infants with prolonged course of parenteral nutrition were eligible for this study; 11 (17.74%) of the infants developed PNAC. There were significant differences in terms of gestational age, birth body weight, duration of parenteral nutrition, septic episodes, and average energy intake during the 2nd and 3rd weeks of life between infants with cholestasis and those without cholestasis. Of these risk factors, the duration of parenteral nutrition was most significant after multivariate logistic regression analysis.

Conclusion

Young gestational age, low birth body weight, more sepsis episodes, and long duration of parenteral nutrition were significant risk factors for PNAC in our study. Low energy intake during the 2nd and 3rd weeks of life is a predictor for PNAC.

Key Words:  cholestasis , parenteral nutrition , premature

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PII: S1875-9572(09)60064-4

doi:10.1016/S1875-9572(09)60064-4

Pediatrics & Neonatology
Volume 50, Issue 5 , Pages 202-207, October 2009

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