title: Parenteral Nutrition-Associated Cholestasis in Very Low Birth Weight Infants: A Single Center Experience.
abstract: OBJECTIVE
  Parenteral nutrition (PN)-associated cholestasis (PNAC) is one of the most common complications in very low birth weight infants (VLBWIs). The aim of this study is to evaluate the risk factors of PNAC in VBLWIs.
  
  
  METHODS
  We retrospectively reviewed the medical records of 322 VLBWIs admitted to the neonatal intensive care unit of our hospital from July 1, 2009 to December 31, 2013. We excluded 72 dead infants; 6 infants were transferred to another hospital, and 57 infants were transferred to our hospital at 2 weeks after birth. The infants were divided into the cholestasis and the non-cholestasis groups. PNAC was defined as a direct bilirubin level of ≥2.0 mg/dL in infants administered with PN for ≥2 weeks.
  
  
  RESULTS
  A total of 187 VLBWI were enrolled in this study; of these, 46 infants developed PNAC. Multivariate logistic regression analysis showed that the risk factors of PNAC in VLBWI were longer duration of antimicrobial use (odds ratio [OR] 4.49, 95% confidence interval [95% CI] 4.42-4.58), longer duration of PN (OR 2.68, 95% CI 2.41-3.00), long-term lack of enteral nutrition (OR 2.89, 95% CI 2.43-3.37), occurrence of necrotizing enterocolitis (OR 2.40, 95% CI 2.16-2.83), and gastrointestinal operation (OR 2.19, 95% CI 2.03-2.58).
  
  
  CONCLUSIONS
  The results of this study suggest that shorter PN, aggressive enteral nutrition, and appropriate antimicrobial use are important strategies in preventing PNAC.
authors.affiliation: Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Ah-Young
authors.initials: AY
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Ryoung-Kyoung
authors.initials: RK
authors.lastname: Lim
authors.affiliation: Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Young-Mi
authors.initials: YM
authors.lastname: Han
authors.affiliation: Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Kyung-Hee
authors.initials: KH
authors.lastname: Park
authors.affiliation: Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea.; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Shin-Yun
authors.initials: SY
authors.lastname: Byun
keywords: Cholestasis; Parenteral nutrition; Very low birth weight infant