A contemporary analysis of parenteral nutrition-associated liver disease in surgical infants

作者：Javid Patrick J^*; Malone Frances R; Dick Andre A S; Hsu Evelyn; Sunseri Maria; Healey Patrick; Horslen Simon P

来源：Journal of Pediatric Surgery, 2011, 46(10): 1913-1917.

DOI：10.1016/j.jpedsurg.2011.06.002

• Parenteral nutrition
• Cholestasis
• Liver disease
• Neonatal surgery
• Abdominal surgery

Background/purpose: Despite advances in pediatric nutritional support and a renewed focus on management of intestinal failure, there are limited recent data regarding the risk of parenteral nutrition (PN)-associated liver disease in surgical infants. This study investigated the incidence of cholestasis from PN and risk factors for its development in this population.
Methods: A retrospective review was performed of all neonates in our institution who underwent abdominal surgery and required postoperative PN from 2001 to 2006. Cholestasis was defined as 2 conjugated bilirubin levels greater than 2 mg/dL over 14 days. Nonparametric univariate analyses and multivariate logistic regression were used to model the likelihood of developing cholestasis. Median values with range are presented.
Results: One hundred seventy-six infants met inclusion criteria, and patients received PN for 28 days (range, 2-256 days). The incidence of cholestasis was 24%. Cholestatic infants were born at an earlier gestational age (34 vs 36 weeks; P<.01), required a 3-fold longer PN duration (76 vs 21 days; P<.001), had longer inpatient stays (86 vs 29 days; P<.001), and were more likely to be discharged on PN. The median time to cholestasis was 23 days. Cholestasis was an early development; 77% of cholestatic infants developed cholestasis by 5 weeks of PN exposure. On multivariate regression, only prematurity was significantly associated with development of cholestasis (P<.05).
Conclusion: In this analysis, the development of PN-associated liver disease occurred early in the course of exposure to PN. These data help to define the time course and prognosis for PN-associated cholestasis in surgical infants.

• 出版日期2011-10