title: Composition of parenteral nutrition solution affects the time of occurrence but not the incidence of cholestasis in surgical infants.
abstract: Parenteral nutrition-associated cholestasis (PNAC) is one of the most important complications of parenteral nutrition (PN). This study was conducted to define the incidence, characteristics and precipitating factors of PNAC in infants treated with two different PN regimens in the pediatric surgery department. The records of infants who received two different PN regimens during January 2000-May 2008 (Group 1) and June 2008-May 2012 (Group 2) were reviewed retrospectively. Patients with and without PNAC comprised the study (Groups 1a-2a) and control groups (Groups 1b-2b), respectively. With Group 1 (n=109) and Group 2 (n=46) constituted as indicated, Group 1a (n=13), Group 1b (n=32), Group 2a (n=6) and Group 2b (n=8) were evaluated. The incidence of PNAC was 14.1% (n=22), and the type of PN regimen did not affect the incidence (14.6% vs. 13.0%, p=0.39). The duration of PN was longer in Group 1a than in Group 1b (34 ± 3 7 vs. 13 ± 10 days, p=0.01), and longer in Group 2a than in Group 1a or Group 2b (146 ± 148 vs. 34 ± 37 days, p=0.02, and 14.0 ± 5.9 days, p=0.002). PNAC developed later in Group 2a than in Group 1a (42.0 ± 24.6 vs. 9.0 ± 8.3 day, p=0.02). The lipid dosage was higher in Group 1a than in Group 1b (3.5 ± 0.7 vs. 3.45 ± 0.54 g/ kg/day, p=0.001) or Group 2a (2.2 ± 0.4 g/kg/day, p=0.01). The lipid dosage was also higher in Group 2a than in Group 2b (p=0.001). Two different regimens resulted in similar PNAC rates. The composition of nutrients in PN solution affects the time of occurrence but not the duration of PNAC. PNAC should be detected as early as possible and treated promptly.
authors.affiliation: Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey. ikarnak@hacettepe.edu.tr.
authors.forename: Burak
authors.initials: B
authors.lastname: Ardıçlı
authors.forename: İbrahim
authors.initials: İ
authors.lastname: Karnak
authors.forename: Arbay Özden
authors.initials: AÖ
authors.lastname: Çiftçi
authors.forename: Hasan
authors.initials: H
authors.lastname: Özen
authors.forename: F Cahit
authors.initials: FC
authors.lastname: Tanyel
authors.forename: Mehmet Emin
authors.initials: ME
authors.lastname: Şenocak
mesh_terms: D002779:Cholestasis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D010288:Parenteral Nutrition; D057947:Parenteral Nutrition Solutions / Q000737:chemistry*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011184:Postoperative Period; D012189:Retrospective Studies; D014421:Turkey / Q000453:epidemiology
chemical_list: D057947:Parenteral Nutrition Solutions