Could lipid infusion be a risk for parenteral nutrition-associated cholestasis in low birth weight neonates?
To assess whether lipid infusion could be a risk factor for parenteral nutrition-associated cholestasis (PNAC) in low birth weight neonates, 22 newborns with cholestasis (29.8 +/- 1.6 weeks, 1298 +/- 217 g) were compared with 22 without cholestasis (29.5 +/- 1.7 weeks, 1286 +/- 363 g). The mean level of peak direct bilirubin for the cholestasis group was 4.6 mg/dl compared to 1.2 mg/dl for the noncholestasis group. A univariate analysis revealed that PNAC was significantly related to duration of fasting (p = 0.008) and parenteral nutrition (p < 0.0001), days of antibiotics use (p = 0.025), positive C-reactive protein (p = 0.018) or gastric culture (p = 0.018), and feeding intolerance (p < 0.0001). Total amino acid amount (p < 0.0001), total lipid amount (p < 0.0001), and average daily lipid amount (p = 0.002) were significantly higher in the cholestasis group than in the noncholestasis group. Conversely, prenatal administration of dexamethasone was a significant protective factor of PNAC (p = 0.008). Logistic regression analysis revealed that the cumulative amount of lipid infusion was an independent risk factor for PNAC (p = 0.041; OR 1.174; CI 1.007-1.369). We suggest that decreasing the cumulative load of amino acids and intralipids with early trophic feeding, control of infection, and prenatal administration of dexamethasone could possibly attenuate the severity of PNAC.
Shin
Jae Il
JI
Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital, 134 Shinchon-Dong, Seodaemun-Ku, C.P.O. Box 8044, 120-752, Seoul, South Korea.
Namgung
Ran
R
Park
Min Soo
MS
Lee
Chul
C
D002779:Cholestasis / Q000209:etiology*; D002149:Energy Intake; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000628:therapy; D007236:Infant, Small for Gestational Age; D008055:Lipids / Q000008:administration & dosage* / Q000009:adverse effects; D016015:Logistic Models; D015999:Multivariate Analysis; D010288:Parenteral Nutrition / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors
D008055:Lipids