title: Parenteral nutrition-induced cholestasis in neonates: where does the problem lie?
abstract: Background. Parenteral nutrition (PN) is an effective method of nourishing the neonate who is unable to receive full enteral feeds. Cholestasis can be a complication of PN and can lead to severe liver damage. Aim. We describe our patient population and determine risk factors for developing PN cholestasis. Methods. Retrospective chart review of newborns admitted from January 2006 to May 2011 to the Neonatal Intensive Care Unit at our institution and received PN >14 days. Cholestasis was defined as serum conjugated bilirubin >50  μ mol/L. Results. Eighty-seven newborns were included; 18 (20.7%) developed PN cholestasis. The most frequent surgical condition for both groups was gastroschisis (8/87; 9.2%). No significant differences were found between the cholestasis and control groups for the following parameters: birth weight, gestational age, intrauterine growth restriction, Apgar scores, and day of life at initiation of enteral feeds. Duration of PN in days and dosage of carbohydrates in g/kg/day were significantly higher in the cholestasis group than the control group. Conclusion. PN-related cholestasis presented in one-fifth of neonates receiving PN for more than two weeks. Longer duration of PN and higher dosage of carbohydrates were independent risk factors for the development of PN cholestasis in this population.
authors.affiliation: University of Ottawa, Ottawa, ON, Canada K1H 8L1.
authors.forename: Kheira
authors.initials: K
authors.lastname: Jolin-Dahel
authors.affiliation: University of Ottawa, Ottawa, ON, Canada K1H 8L1 ; Department of Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada K1H 8L1.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Ferretti
authors.affiliation: University of Ottawa, Ottawa, ON, Canada K1H 8L1 ; Department of Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada K1H 8L1.
authors.forename: Carolina
authors.initials: C
authors.lastname: Montiveros
authors.affiliation: Department of Statistics, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada K1H 8L1.
authors.forename: Renee
authors.initials: R
authors.lastname: Grenon
authors.affiliation: Department of Statistics, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada K1H 8L1.
authors.forename: Nick
authors.initials: N
authors.lastname: Barrowman
authors.affiliation: University of Ottawa, Ottawa, ON, Canada K1H 8L1 ; Department of Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada K1H 8L1.
authors.forename: Carolina
authors.initials: C
authors.lastname: Jimenez-Rivera