Total Parenteral Nutrition-associated Cholestasis in Very Low Birth Weight Infants

ABSTRACT

PURPOSE: Very low birth weigh infants (VLBWI), who often require a long-term parenteral nutrition, are at high risk for the development of parenteral nutrition-associated cholestasis. This study was conducted to determine the incidence of total parenteral nutrition (TPN)-associated cholestasis and its risk factors in the VLBI. We evaluated the clinical courses and outcomes. METHODS: The hospital records of 165 VLBWI who were admitted to the neonatal intensive care unit at Asan medical center from Jan. 1997 to Dec. 1999 and received TPN for more than 2 weeks were reviewed. Cholestasis was defined as a direct serum bilirubin level greater than 2.0 mg/dl during the period of TPN, and other causes of cholestasis were ruled out. RESULTS: Twenty-seven out of 165 VLBWI developed TPN-associated cholestasis with the incidence of 16.4%. Significant risk factors for the development of cholestasis included birth weight, small for gestational age, duration of enteral starvation, duration of parenteral nutrition, septic episodes, necrotizing enterocolitis, and the number of surgery in 30 days of age. Cholestasis occurred at the mean age of 48.8+/-20.7 days and resolved in 53.7+/-8.8 days after onset of cholestasis. The mortality rate of infants with cholestasis was significantly higher than that of infants without cholestasis. Two infants appeared to die of a progressive hepatic dysfunction associated with TPN. CONCLUSION: TPN-associated cholestasis is relatively common in VLBWI, and may progress to the hepatic failure and death. The strategies such as early enteral feeding or the reduction of septic episodes would need to be seriously adopted in order to prevent the morbidity and mortality from TPN-associated cholestasis.