title: Incidence and Risk Factors of Parenteral Nutrition-Associated Cholestasis in Omani Neonates: Single centre experience.
abstract: OBJECTIVE
  Parenteral nutrition-associated cholestasis (PNAC) is one of the most challenging complications of prolonged parenteral nutrition (PN) in neonates. There is a lack of research investigating its incidence in newborn infants in Oman and the Arab region. Therefore, this study aimed to assess the incidence of PNAC and its risk factors in Omani neonates.
  
  
  METHODS
  This retrospective study took place between January and April 2014. All neonates who received PN for ≥14 days during a four-year period (June 2009 to May 2013) at the neonatal intensive care unit (NICU) in Sultan Qaboos University Hospital, Muscat, Oman, were enrolled.
  
  
  RESULTS
  A total of 1,857 neonates were admitted to the NICU over the study period and 135 neonates (7.3%) received PN for ≥14 days. Determining the incidence of PNAC was only possible in 97 neonates; of these, 38 (39%) had PNAC. The main risk factors associated with PNAC were duration of PN, duration of enteral starvation, gastrointestinal surgeries, blood transfusions and sepsis. Neonates with PNAC had a slightly higher incidence of necrotising enterocolitis in comparison to those without PNAC.
  
  
  CONCLUSIONS
  This study found a PNAC incidence of 39% in Omani neonates. There were several significant risk factors for PNAC in Omani neonates; however, after logistic regression analysis, only total PN duration remained statistically significant. Preventive strategies should be implemented in NICUs so as to avoid future chronic liver disease in this population.
authors.affiliation: Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman;
authors.forename: Sharef W
authors.initials: SW
authors.lastname: Sharef
authors.affiliation: Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman;
authors.forename: Siham
authors.initials: S
authors.lastname: Al-Sinani
authors.affiliation: Department of Medicine, Armed Forces Hospital, Muscat, Oman;
authors.forename: Khalid
authors.initials: K
authors.lastname: Al-Naamani
authors.affiliation: Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman;
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Al-Zakwani
authors.affiliation: Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman;
authors.forename: Zenaida S
authors.initials: ZS
authors.lastname: Reyes
authors.affiliation: Oman Medical Speciality Board, Muscat, Oman.
authors.forename: Hilal
authors.initials: H
authors.lastname: Al-Ryiami
authors.affiliation: Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman;
authors.forename: Ashfaq A
authors.initials: AA
authors.lastname: Khan
authors.affiliation: Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman;
authors.forename: Watfa
authors.initials: W
authors.lastname: Al-Mamari
keywords: Cholestasis; Incidence; Neonates; Oman; Parenteral Nutrition; Risk Factors