A contemporary analysis of parenteral nutrition-associated liver disease in surgical infants.
OBJECTIVE
Despite advances in pediatric nutritional support and a renewed focus on management of intestinal failure, there are limited recent data regarding the risk of parenteral nutrition (PN)-associated liver disease in surgical infants. This study investigated the incidence of cholestasis from PN and risk factors for its development in this population.


METHODS
A retrospective review was performed of all neonates in our institution who underwent abdominal surgery and required postoperative PN from 2001 to 2006. Cholestasis was defined as 2 conjugated bilirubin levels greater than 2 mg/dL over 14 days. Nonparametric univariate analyses and multivariate logistic regression were used to model the likelihood of developing cholestasis. Median values with range are presented.


RESULTS
One hundred seventy-six infants met inclusion criteria, and patients received PN for 28 days (range, 2-256 days). The incidence of cholestasis was 24%. Cholestatic infants were born at an earlier gestational age (34 vs 36 weeks; P < .01), required a 3-fold longer PN duration (76 vs 21 days; P < .001), had longer inpatient stays (86 vs 29 days; P < .001), and were more likely to be discharged on PN. The median time to cholestasis was 23 days. Cholestasis was an early development; 77% of cholestatic infants developed cholestasis by 5 weeks of PN exposure. On multivariate regression, only prematurity was significantly associated with development of cholestasis (P < .05).


CONCLUSIONS
In this analysis, the development of PN-associated liver disease occurred early in the course of exposure to PN. These data help to define the time course and prognosis for PN-associated cholestasis in surgical infants.
Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA 98105, USA. patrick.javid@seattlechildrens.org
Patrick J
PJ
Javid
Frances R
FR
Malone
André A S
AA
Dick
Evelyn
E
Hsu
Maria
M
Sunseri
Patrick
P
Healey
Simon P
SP
Horslen
D002779:Cholestasis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D003953:Diagnosis-Related Groups; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D015994:Incidence; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000601:surgery*; D007235:Infant, Premature, Diseases / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D018529:Nutritional Support; D010288:Parenteral Nutrition / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
D014580:Ursodeoxycholic Acid