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Original Article

Associated Factors with Parenteral Nutrition Associated Cholestasis in Neonates

Kyoung Eun Kim1, Hyon Hui Lee2, Mi Lim Chung2, Woon Won Kim1, So Hyun Nam3
Journal of the Korean Association of Pediatric Surgeons 2015;21(1):1-6.
Published online: June 24, 2015

1Department of Surgery, Inje University Haeundae Paik Hospital, Busan, Korea.

2Department of Pediatrics, Inje University Haeundae Paik Hospital, Busan, Korea.

3Department of Surgery, Dong-A University College of Medicine, Busan, Korea.

Correspondence: So Hyun Nam, Department of Surgery, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-gu, Busan 602-715, Korea. Tel: +82-51-240-5146, Fax: +82-51-247-9316, d011029@naver.com
• Received: December 15, 2014   • Revised: February 6, 2015   • Accepted: April 13, 2015

Copyright © 2015 by the Korean Association of Pediatric Surgeons

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    Long time total parenteral nutrition (TPN) can induce irreversible liver damage. In this study, we investigated the associated factors of parenteral nutrition associated cholestasis (PNAC) in neonates.
  • Methods
    We retrospectively reviewed 227 neonates (male:female=110:117) those who had received TPN over 2 weeks from March 2010 to February 2014. PNAC was defined as direct bilirubin was higher than 2.0 mg/dL without any cause except TPN.
  • Results
    Overall incidence was 28.6%. PNAC was frequently developed in younger gestational age with lower birth weight. Episodes of sepsis, underlying bronchopulmonary dysplasia, history of necrotizing enterocolitis, and experience of gastrointestinal surgery increase the incidence of PNAC. PNAC was directly associated the duration of TPN and long period to full enteral feeding, reaching 60 and 150 mL/kg/day. Overall mortality rate was 9.7%. It was higher in PNAC group despite PNAC was not the primary cause of death. All survivors were recovered from cholestasis with encourage of enteral nutrition.
  • Conclusion
    PNAC in neonate was associated with younger gestational ages and lower birth weights, duration of TPN, or who experienced sepsis, necrotizing enterocolitis, gastrointestinal surgery or bronchopulmonary dysplasia.
  • Keywords: Newborn infant; Parenteral nutrition; Cholestasis

No potential conflict of interest relevant to this article was reported.

The abstract of this article was presented at the 30th Annual Meeting of the Korean Association of Pediatric Surgeons on June 2014 in Busan, Korea.

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Table 1
Clinical Characteristics

Values are presented as mean±SD, ratio, or n (%).

PNAC, parenteral nutrition associated cholestasis; TPN, total parenteral nutrition; EN, enteral nutrition.

jkaps-21-1-i001.jpg
Table 2
Cause of Death

PNAC, parenteral nutrition associated cholestasis; PPHN, pulmonary hypertension of the newborn.

jkaps-21-1-i002.jpg
Table 3
Co-morbidities

Values are presented as n (%).

PNAC, parenteral nutrition associated cholestasis; BPD, bronchopulmonary dysplasia; NEC, necrotizing enterocolitis; GI, gastrointestinal.

jkaps-21-1-i003.jpg
Table 4
Laboratory Findings

Values are presented as mean±SD.

PNAC, parenteral nutrition associated cholestasis.

jkaps-21-1-i004.jpg
Table 5
Radiologic Findings

Values are presented as n (%) or n only.

PNAC, parenteral nutrition associated cholestasis.

jkaps-21-1-i005.jpg
Table 6
Macronutrients

Values are presented as n (%).

PNAC, parenteral nutrition associated cholestasis; LCT, long chain triglycerides; MCT, medium chain triglycerides.

jkaps-21-1-i006.jpg

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Associated Factors with Parenteral Nutrition Associated Cholestasis in Neonates
J Korean Assoc Pediatr Surg. 2015;21(1):1-6.   Published online June 24, 2015
DOI: https://doi.org/10.13029/jkaps.2015.21.1.1
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Associated Factors with Parenteral Nutrition Associated Cholestasis in Neonates
J Korean Assoc Pediatr Surg. 2015;21(1):1-6.   Published online June 24, 2015
DOI: https://doi.org/10.13029/jkaps.2015.21.1.1
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Associated Factors with Parenteral Nutrition Associated Cholestasis in Neonates
Associated Factors with Parenteral Nutrition Associated Cholestasis in Neonates

Clinical Characteristics

Values are presented as mean±SD, ratio, or n (%).

PNAC, parenteral nutrition associated cholestasis; TPN, total parenteral nutrition; EN, enteral nutrition.

Cause of Death

PNAC, parenteral nutrition associated cholestasis; PPHN, pulmonary hypertension of the newborn.

Co-morbidities

Values are presented as n (%).

PNAC, parenteral nutrition associated cholestasis; BPD, bronchopulmonary dysplasia; NEC, necrotizing enterocolitis; GI, gastrointestinal.

Laboratory Findings

Values are presented as mean±SD.

PNAC, parenteral nutrition associated cholestasis.

Radiologic Findings

Values are presented as n (%) or n only.

PNAC, parenteral nutrition associated cholestasis.

Macronutrients

Values are presented as n (%).

PNAC, parenteral nutrition associated cholestasis; LCT, long chain triglycerides; MCT, medium chain triglycerides.

Table 1 Clinical Characteristics

Values are presented as mean±SD, ratio, or n (%).

PNAC, parenteral nutrition associated cholestasis; TPN, total parenteral nutrition; EN, enteral nutrition.

Table 2 Cause of Death

PNAC, parenteral nutrition associated cholestasis; PPHN, pulmonary hypertension of the newborn.

Table 3 Co-morbidities

Values are presented as n (%).

PNAC, parenteral nutrition associated cholestasis; BPD, bronchopulmonary dysplasia; NEC, necrotizing enterocolitis; GI, gastrointestinal.

Table 4 Laboratory Findings

Values are presented as mean±SD.

PNAC, parenteral nutrition associated cholestasis.

Table 5 Radiologic Findings

Values are presented as n (%) or n only.

PNAC, parenteral nutrition associated cholestasis.

Table 6 Macronutrients

Values are presented as n (%).

PNAC, parenteral nutrition associated cholestasis; LCT, long chain triglycerides; MCT, medium chain triglycerides.

Table 1

Table 2

Table 3

Table 4

Table 5

Table 6

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