Clinical analysis of risk factors of parenteral nutrition-associated cholestasis in very low birthweight infants

Abstract

Objective To investigate the risk factors of parenteral nutrition-associated cholestasis (PNAC) in very low birth weight infants (VLBWI). Methods VLBWI who were accorded with inclusion and exclusion criteria of this study: treatment for parenteral nutrition (PN) for over 14 days in West China Second University Hospital of Sichuan University from May 2008 to May 2014 were chosen as study subjects. By retrospectively analyzed method, they were divided into PNAC group and non PNAC group according to whether suflered from PNAC or not. First of all, according to the clinical experience, the influence factors of PNAC were identified and carried on the single factor analysis, then comprehensively considered with statistically significant variables and professional knowledge, multiple factors unconditional logistic regression analysis method was used to further analyze the independent and risk factors of PNAC. Results ①A total of 172 cases of VLBWI were chosen as study subjects finally. According to whether suffered from PNAC or not, they were divided into PNAC group (n=29) and non PNAC group (n=143), and the incidence of PNAC was 16.9%. There were no significant differences between two groups among gender ratio, gestational age at delivery and mode of delivery, etc. (P>0.05). ②According to clinical experience, the single factor analysis results about 27 clinical observation items and 19 nutritional factors which may lead to PNAC showed that 8 clinical observation items and 5 nutritional factors were influence factors of PNAC, such as VLBWI, less than appropriate for gestational age (SGA), long fasting time and longer duration of PN, higher amino acid and fat emulsion calories, milk lower calories, higher neonatal infections, such as infectious pneumonia, sepsis, neonatal necrotizing enterocolitis (NEC) and septic shock rate, lower breastfeeding and oral probiotics rate, and all the differences were statistically significant (t/χ2=3.306, 3.306, 1.790, 1.231, 3.193, 2.815, 2.519, 4.615, 3.949, 3.920, 3.861, 5.656, 5.535; P<0.05). The unconditioned and multi-factor of logistic regression analysis results of influence factors may cause PNAC showed that neonatal infections, SGA, VLBWI, long fasting time, long duration of PN, higher amino acid and fat emulsion calories were the risk factors of PNAC (OR=8.785, 8.785, 8.785, 3.851, 6.746, 7.113, 3.765; 95%CI: 3.603-25.236, 1.526-8.932, 2.534-19.651, 1.473-15.326, 1.219-12.471, 3.124-19.358, 3.230-26.246; P<0.05), milk high calorie, breastfeeding and oral probiotics were protective factors of PNAC (OR=0.016, 0.016, 0.016; 95%CI: 0.027-0.679, 0.076-0.531, 0.013-0.169; P<0.05). Conclusions Neonatal infections, SGA, low birth weight, long duration of PN, higher amino acid and fat emulsion calorie, long fasting time are significant risk factors of PNAC in our study. Protective factors are high milk calorie, breastfeeding and oral probiotics. Key words: Parenteral nutrition-associated cholestasis; Risk factors; Birth weight; Very low birth weight; Infant, newborn