Discuss Of Risk Factors And Early Diagnostic Indicator Of Parenteral Nutrition-associated Cholestasis In Preterm Infants

ObjectiveThis study aims to determine risk factors and sensitive indicator of parente ral nutrition associated cholestasis in preterm infant, so as to early diagnosis an d intervene, for reduce complications.Patients and Methods1.PatientsThe clinical data of preterm infants receiving parenteral nutrition for14da ys or over,who come from Neonatal Intensive Care Unit of Shandong Provinci al Hospital between Mar2008and Feb2011.Of these infants who had PNAC were aligned into the PNAC group,and the others without PNAC were aligned into the non-PNAC group.2.Parenteral nutrition methodsAll premature from24to72hours after birth was feed through mouth, who intolerance oral feeding or oral feeding is inadequate, given PN nutrition1iquid.Start quantity of liquid is80ml-kg-1·d-1, the daily increase of10to20ml,u ntil140to160ml·kg-1·d-1.Parenteral nutrition solutions including glucose, amino acids, lipid emulsions,vitamins, electrolytes, trace elements.The first day of birt h gave10％glucose,from6～8g/(kg-d) increase to12-16g/(kg-d) gradually; at the same time gave compound amino acids,from1g/(kg·d) increase to3～3.5g/(kg·d);The second day gave lipid emulsions,from1g/(kg·d) increase to3g/(k g-d);Make use of micro pump input to peripheral vein about16-24hours.Ace ording to the gastrointestinal tolerance situation gradually transition to completel y through the mouth to feed.3.Observation indexesAll infants are taken notes of age,sex,gestational age, birth weight,diagnosis, complications, mechanical ventilation,hepatitis virus series,TORCH,thyroid functi on,blood antibody,feeding situation and PN related content(fasting time,parenteral nutrition duration,amino acids dosage,fat emulsion dosage,calorie intake,proporti on of protein and nonprotein).Liver function examination results:TBil(Total bilir ubin), DBil(Direct bilirubin),TBA(Total bile acid),ALP(Alkaline phosphatase),AS T(Aspartate transaminase),ALT(Alanine aminotransferase),GGT(y-Glutamyl transfe res).Results1.The incidence of PNAC were25.6%.Compared with non-PNAC group, the average fasting time,PN duration of PNAC group weight was longer; Fat emulsion dosage, amino acid dosage,calorie intake, proportion of protein and nonprotein.of PNAC was larger than non-PNAC. The proportion of SGA, feeding intolerance, assisted respiration of PNAC was larger than non-PNAC.2.Tests for hepatic function between two groups:After2weeks of PN,the serum values of DBil、TBA、ALP、GGT、ALT and AST were significantly higher in PNAC group(P＜0.01).3.The AUC of two groups’hepatic function tests:The ACU of TAB is0.909,and the value was significantly higher than that of AST、GGT、ALT、ALP,which was0.751、0.721、0.704、0.636respectively.4.The sensitivity was87.9％and the specificity was87.7％when the the cutoff value of TBA was26.2umol/L,at which there was the highest diagnosis value.5.The value of TBA correlated well to the value of DBIL, r was0.563.Conclusion1.The PNAC risk factors were longer fasting time and duration of PN, mor e fat emulsion and amino acid dosage,higher energy intake of PN. Higher prop ortion of SGA, feeding intolerance, assisted respiration.2.The sensitivity and specificity of serum TBA was superior than other in dicators, regular monitoring DBil and TBA will helpful to detect PNAC earlier in preterm infant.