Risk factor analysis of parenteral nutrition-associated cholestasis in extremely low birth weight infants.
OBJECTIVE
Parenteral nutrition (PN) provides an alternative nutrition source for preterm infants who are intolerant of enteral nutrition. However, prolonged PN increases the risk of PN-associated cholestasis (PNAC). We conducted this study to determine the incidence and risk factors of PNAC in extremely low birth weight (ELBW) infants.


METHODS
We retrospectively reviewed the medical records of ELBW infants from March 2010 to April 2015. PNAC was diagnosed in infants with a history of PN for at least two weeks and direct bilirubin concentrations >2 mg/dL after other causes of neonatal cholestasis were excluded.


RESULTS
Of the 114 eligible ELBW infants, 41 (36%) were diagnosed with PNAC. The multivariate analysis showed that birth weight, sepsis, necrotising enterocolitis, fluconazole prophylaxis and the duration of PN and hospitalisation were independent risk factors for the development of PNAC (p < 0.05). However, parenteral fish oil-based lipid preparation (FOLP) did not reduce the risk of PNAC. Although PNAC was not a direct cause of death, it was associated with an increased risk of mortality.


CONCLUSIONS
PNAC was common in ELBW infants, was associated with various clinical factors and increased the risk of mortality. However, we did not observe the protective effect of FOLP against PNAC.
Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Pusan, Korea.
Hyon Hui
HH
Lee
Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Pusan, Korea.
Ji Mi
JM
Jung
Department of Surgery, Dong-A University Hospital, University of Dong-A College of Medicine, Pusan, Korea.
So-Hyun
SH
Nam
Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
Gina
G
Lim
Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Pusan, Korea.
Mi Lim
ML
Chung
D002779:Cholestasis / Q000097:blood / Q000209:etiology / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects*; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors
Extremely low birth weight infants; Parenteral nutrition; Parenteral nutrition-associated cholestasis; Risk factors