title: Retrospective Dual-Center Study of Parenteral Nutrition-Associated Cholestasis in Premature Neonates: 15 Years' Experience.
abstract: BACKGROUND
  The pathogenesis of parenteral nutrition-associated cholestasis (PNAC) has not been clarified. The objective of this study was to explore the incidence of PNAC in premature infants without surgery and to identify associated risk factors.
  
  
  METHODS
  Premature neonates who received parenteral nutrition (PN) at least 14 days were included in a retrospective, dual-center study. Cholestasis was diagnosed as conjugated bilirubin ≥2 mg/dL. Infants with metabolic liver disease, cyanotic congenital heart disease, congenital syphilis, hepadnaviridae infection, and those who underwent surgery were excluded. Infants were divided into 3 groups chronologically: group A (2000-2004, n = 50), group B (2005-2009, n = 283), and group C (2010-2014, n = 741). A case-controlled study was conducted by comparing infants with PNAC to those without PNAC.
  
  
  RESULTS
  Of 1074 premature neonates, PNAC was confirmed in 53 infants (4.93%). There were 6.8% very low birth weight (BW) infants and 20.0% extremely low BW infants who developed PNAC. The incidence of PNAC decreased slightly during 2000-2014 (8.0%, 6.4%, and 4.2% in groups A, B, and C, respectively). Compared with those without PNAC, infants with PNAC (n = 53) had significantly younger gestational age, lower BW, longer PN duration, and higher rate of sepsis. Logistic regression showed male sex, PN duration ≥43 days, and sepsis were statistically correlated with PNAC.
  
  
  CONCLUSIONS
  Prolonged duration (≥43 days), male sex, and sepsis are probably independent risk factors for developing PNAC in premature neonates.
authors.affiliation: 1 Department of Clinical Nutrition, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.|2 Shanghai Institute of Pediatric Research, Shanghai, China.|3 Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China.
authors.forename: Weihui
authors.initials: W
authors.lastname: Yan
authors.affiliation: 4 Department of Clinical Nutrition, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Li
authors.initials: L
authors.lastname: Hong
authors.affiliation: 1 Department of Clinical Nutrition, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.|2 Shanghai Institute of Pediatric Research, Shanghai, China.|3 Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Wang
authors.affiliation: 4 Department of Clinical Nutrition, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Feng
authors.affiliation: 1 Department of Clinical Nutrition, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.|2 Shanghai Institute of Pediatric Research, Shanghai, China.|3 Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China.
authors.forename: Lina
authors.initials: L
authors.lastname: Lu
authors.affiliation: 1 Department of Clinical Nutrition, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.|2 Shanghai Institute of Pediatric Research, Shanghai, China.|3 Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China.
authors.forename: Yijing
authors.initials: Y
authors.lastname: Tao
authors.affiliation: 1 Department of Clinical Nutrition, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.|2 Shanghai Institute of Pediatric Research, Shanghai, China.|3 Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Wu
authors.affiliation: 1 Department of Clinical Nutrition, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.|2 Shanghai Institute of Pediatric Research, Shanghai, China.|3 Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China.
authors.forename: Huijuan
authors.initials: H
authors.lastname: Ruan
authors.affiliation: 1 Department of Clinical Nutrition, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.|2 Shanghai Institute of Pediatric Research, Shanghai, China.|3 Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China.
authors.forename: Qingya
authors.initials: Q
authors.lastname: Tang
authors.affiliation: 1 Department of Clinical Nutrition, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.|2 Shanghai Institute of Pediatric Research, Shanghai, China.|3 Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China.|5 Department of Pediatric Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Cai
mesh_terms: D000596:Amino Acids / Q000008:administration & dosage; D001663:Bilirubin; D016022:Case-Control Studies; D002779:Cholestasis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D004041:Dietary Fats / Q000008:administration & dosage; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D016015:Logistic Models; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D018401:Sample Size; D018805:Sepsis / Q000175:diagnosis / Q000209:etiology
chemical_list: D000596:Amino Acids; D004041:Dietary Fats; D001663:Bilirubin
keywords: cholestasis; nutrition support; parenteral nutrition; premature infant; risk factors