title: The association of cyclic parenteral nutrition and decreased incidence of cholestatic liver disease in patients with gastroschisis.
abstract: OBJECTIVE
  The aim of the study was to investigate the effect of prophylactic cycling of parenteral nutrition (PN) on PN-induced cholestasis in patients with gastroschisis.
  
  
  METHODS
  Retrospective review of initial hospital admission charts for each patient with gastroschisis from 1996 to 2007 was performed.
  
  
  RESULTS
  One hundred seven patients were analyzed (36 prophylactically cycled, 71 control). Prophylactic cycling of PN was initiated at a mean age of 23 days (range, 7-89 days). Patients were followed for a total of 4255 days with 27 developing hyperbilirubinemia (cycled, 5; continuous, 22). Time to hyperbilirubinemia was longer in the prophylactically cycled group (P = .005). Cumulative incidence of hyperbilirubinemia at 25 and 50 days of PN exposure was 5.7% and 9.8% (cycled) vs 22.3% and 48.8% (continuous). At any given time, children in the continuous group were 4.76 times more likely to develop hyperbilirubinemia (95% confidence interval, 1.62-14.00). After adjusting for confounding factors, children in the continuous group were 2.86 times more likely to develop hyperbilirubinemia (95% confidence interval, 0.86-9.53), but the difference was not significant (P = .088).
  
  
  CONCLUSIONS
  Prophylactic cyclic PN is associated with a decreased incidence and prolonged time to onset of hyperbilirubinemia. Other factors, however, significantly affect this relationship. Prospective randomized investigation is warranted to investigate for a possible causal relationship.
authors.affiliation: Department of Surgery, University of Washington School of Medicine, Seattle, USA.
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Jensen
authors.forename: Adam B
authors.initials: AB
authors.lastname: Goldin
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Koopmeiners
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stevens
authors.forename: John H T
authors.initials: JH
authors.lastname: Waldhausen
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Kim
mesh_terms: D002779:Cholestasis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D020139:Gastroschisis / Q000628:therapy*; D006801:Humans; D006932:Hyperbilirubinemia / Q000209:etiology; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome