Increased incidence of parenteral nutrition-associated cholestasis with aminosyn PF compared to trophamine.
OBJECTIVE
To compare the incidence of parenteral nutrition-associated cholestasis (PNAC) between two pediatric parenteral amino-acid formulations, Aminosyn PF (APF) and Trophamine (TA).


METHODS



METHODS
Tertiary newborn intensive-care nursery.


METHODS
A total of 661 neonates who received either TA or APF.


METHODS
Retrospective. The incidence of PNAC was determined in three groups: Group I (TA, 8/19/97 to 8/19/98, n=335), Group II (APF, 8/20/98 to 1/28/99, n=157), and Group III (TA, 1/29/99 to 8/1/99, n=169).


RESULTS
No PNAC developed in any infant receiving parenteral nutrition (PN) for < 3 weeks. Of 141 patients given PN for > or =21 days, 24 were diagnosed with PNAC: Group I (TA, 10/78, 12.8%), Group II (APF, 9/27, 33.3%), and Group III (TA, 5/36, 13.9%). The incidence of PNAC was significantly higher in infants who received APF (p=0.043). Using logistic regression, only birth weight, duration of PN, and use of APF were significant risk factors for the development of PNAC. Despite an earlier initiation of enteral feedings, APF recipients developed PNAC sooner, had higher peak direct bilirubin levels, and remained jaundiced longer.


CONCLUSIONS
The use of APF was temporally associated with a greater than two-fold increase in the incidence of PNAC compared to periods of exclusive TA use. In the absence of significant differences in parenteral nutrient or energy intake in neonates who developed PNAC, we speculate that possible differences between the amino-acid compositions of TA and APF may be responsible for the observed differences in the incidence of PNAC.
D000596:Amino Acids / Q000008:administration & dosage / Q000009:adverse effects*; D001663:Bilirubin / Q000097:blood; D002779:Cholestasis / Q000209:etiology*; D004573:Electrolytes; D002149:Energy Intake; D005260:Female; D005947:Glucose; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects*; D057947:Parenteral Nutrition Solutions; D012189:Retrospective Studies; D012307:Risk Factors; D012996:Solutions
D000596:Amino Acids; D004573:Electrolytes; D057947:Parenteral Nutrition Solutions; D012996:Solutions; C545824:amino-acid, glucose, and electrolyte solution; D005947:Glucose; D001663:Bilirubin