Preterm small for gestational age infants are not at higher risk for parenteral nutrition-associated cholestasis.
OBJECTIVE
To assess if being small for gestational age impacts parenteral nutrition-associated cholestasis (PNAC) development.


METHODS
We reviewed all the very low-birth weight infants exposed to parenteral nutrition for >14 days from 1996 to 2006, comparing auxological and clinical data, as well as nutritional history, during the first 4 weeks of life of infants with cholestasis and control subjects.


RESULTS
Of 445 very low-birth weight infants, 55 had development of PNAC. Infants with cholestasis had lower birth weight and gestational age but similar birth weight z-score compared with infants without cholestasis, and they received a lower amount of enteral feeds (25.8 +/- 20.7 vs 67.9 +/- 33.0 mL/kg, P < .001), a greater amount of intravenous glucose (10.6 +/- 1.3 vs 7.5 +/- 2.5 g/kg, P < .0001), lipids (1.8 +/- 0.4 vs 1.3 +/- 0.5, P < .0001) and proteins (2.7 +/- 0.5 vs 1.9 +/- 0.7, P < .0001), and needed a higher number of days of fasting (13.2 +/- 6.7 vs 6.5 +/- 4.8, P < .001). Enteral intake between 0 and 21 days of life (OR 0.66; 95% CI 0.53, 0.81, P < .0001) and oxygen therapy (OR 1.05; 95% CI 1.01, 1.09; P = .030) were identified as the best independent predictors of PNAC.


CONCLUSIONS
Enteral feeding remains the main factor for the prevention of PNAC, whereas small for gestational age infants do not have a higher risk of PNAC.
Costa
Simonetta
S
Division of Neonatology, Department of Paediatrics, Catholic University Sacred Heart, Rome, Italy. simocosta@yahoo.it
Maggio
Luca
L
Sindico
Paola
P
Cota
Francesco
F
De Carolis
Maria Pia
MP
Romagnoli
Costantino
C
D002779:Cholestasis / Q000453:epidemiology / Q000209:etiology*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007558:Italy / Q000453:epidemiology; D010288:Parenteral Nutrition / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors