Clinical high-risk factors of parenteral nutrition-associated cholestasis in very low birth weight infants / 中华临床营养杂志

ABSTRACT

Objective To investigate the clinical characteristics and high-risk factors of parenteral nutrition-associated cholestasis (PNAC) in very low birth weight infants (VLBWI),so as to guide the prevention and treatment of this condition.Methods A retrospective analysis was conducted with the data of 141 VLBWI collected from January 2013 to October 2014 in Affiliated Hospital of Qingdao University.These VLBWI were of gestational age ≤ 34 weeks and received parenteral nutrition (PN) for ＞ 14 days in Neonatal Intensive Care Unit.According to the existence of PNAC,they were divided into PNAC group (n =32) and non-PNAC group (n =109) and analyzed in terms of clinical features.Results Between the non-PNAC and the PNAC groups,univariate analysis showed significant differences in gestational age [(30.84 ± 1.55) weeks vs.(29.68 ±2.04) weeks,t=2.952,P=0.005],birth weight [(1 267.92±160.39) gvs.(1 050.63 ±229.74) g,t=6.064,P=0.000],hospital stay [(43.26 ±14.43) d vs.(66.47 ±22.25) d,t =-6.622,P=0.000],fasting time [(6.30±5.23) d vs.(11.94±7.92) d,t＝-4.723,P=0.000],PN duration [(32.40 ± 13.72) d vs.(57.59 ± 27.65) d,t =-7.039,P =0.000],the maximum daily dosage of amino acid [(3.61 ±0.27) g/ (kg·d) vs.(3.78±0.35) g/ (kg·d),t=-3.012,P=0.003];concurrent infection (56.88％ vs.87.50％,x2 =10.046,P =0.002),pneumonia (32.11％ vs.68.75％,x2 =13.790,P =0.000),necrotizing enterocolitis (0.92％ vs.9.38％,x2 =6.420,P =0.037),neonatal respiratory distress syndrome (55.05％ vs.78.13％,x2 =5.503,P =0.019),bronchopulmonary dysplasia (19.27％ vs.46.88％,x2 =9.918,P=0.002),congenital heart disease (4.59％ vs.21.88％,x2 =7.405,P =0.007);application of pulmonary surfactant (33.94％ vs.59.38％,x2 =6.682,P =0.010),continuous positive airway pressure ventilation (60.55％ vs.87.50％,x2 =8.085,P =0.004),mechanical ventilation (22.94％ vs.43.75％,x2 =5.356,P =0.021) and peripherally inserted central catheter (44.04％ vs.81.25％,x2 =13.737,P =0.000).Multivariate Logistic regression analysis revealed that PN duration was an independent high-risk factor of PNAC (B =0.069,OR =1.071,95％ CI =1.039-1.104,P =0.000).Conclusions Many factors are associated with PNAC,in which PN duration is an independent high-risk factor.Early enteral nutrition and shortened duration of PN may be protective measures for PNAC.