title: Parenteral Nutrition-Associated Cholestasis in Premature Infants: Role of Macronutrients.
abstract: OBJECTIVE
  To evaluate whether intravenous lipid (IL) intake is associated with the development of parenteral nutrition-associated cholestasis (PNAC) in infants younger than 32 weeks gestational age (GA).
  
  
  METHODS
  A retrospective matched case-control study (1:1) was performed including infants younger than 32 weeks GA admitted to the neonatal intensive care unit within 48 hours after birth. Infants with a chromosomal disorder, TORCH infection (toxoplasmosis, syphilis, rubella, cytomegalovirus, herpes, human immunodeficiency virus, and parvovirus), metabolic disorder, and/or surgical abnormality of the hepatobiliary system were excluded. Infants with PNAC (direct bilirubin 2 mg/dL or higher) comprised the case group, while infants without PNAC comprised the control group. Duration of parenteral nutrition, intravenous fluid intake on the day of development of PNAC, and GA were used as matching criteria.
  
  
  RESULTS
  A total of 46 subjects were studied. Daily average intravenous dextrose (ID) intake was significantly higher in infants with PNAC compared with infants without PNAC (12.72 ± 2.5 g/kg/d and 10.64 ± 2.1 g/kg/d, respectively, P = .004). On comparison of receiver operating characteristic curves, the area under the curve for ID intake (0.74) was significantly higher (P = .01) compared with the area under the curve for IL intake (0.59) and intravenous protein (IP) intake (0.52). On logistic regression, daily ID intake was associated with PNAC (odds ratio 1.7; 95% CI, 1.04-2.9, P = .03) after controlling for daily IP and IL intake.
  
  
  CONCLUSIONS
  ID intake may be associated with the development of PNAC in premature infants. Our findings suggest that limiting ID intake may be more useful than limiting IL intake in reducing the incidence of PNAC in premature infants.
authors.affiliation: Department of Pediatrics, Division of Neonatology.
authors.forename: Kunal
authors.initials: K
authors.lastname: Gupta
authors.affiliation: Biostatistics, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, New York, USA.
authors.forename: Hongyue
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Pediatrics, Division of Neonatology Sanjiv_Amin@urmc.rochester.edu.
authors.forename: Sanjiv B
authors.initials: SB
authors.lastname: Amin
mesh_terms: D061605:Administration, Intravenous; D016022:Case-Control Studies; D002779:Cholestasis / Q000209:etiology*; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005865:Gestational Age; D005947:Glucose / Q000008:administration & dosage; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D004044:Dietary Proteins; D005217:Fat Emulsions, Intravenous; D005947:Glucose
keywords: life cycle; lipids; neonates; nutrition; nutrition, liver disease; parenteral nutrition; research and diseases