The Clinical Research Of Parenteral Nutrition Associated Cholestasis In Very/Extremely Low Birth Weight Infants

Objective:1.The study aims to understand the clinical factors of parenteral nutrition associated cholestasis(PNAC) in very/extremely low birth weight infants(VIBWI/ELBWI),so as to seek for better prevention and cure methods.2.To observe the effect and safety on using L-carnitine in parenteral nutrition(PN) which aim to decrease the incidence of PNAC.Methods: A retrospective study of 128 neonates admitted to our hospital between Jan 2014 and Jan 2016,they all received PN for 14 days with birth weight lower than 1500 g,of these infants who had PNAC were aligned into the PNAC group,and the others without PNAC were aligned into non-PNAC group.Results: 1. of 128 cases(VIBWI 118 cases,ELBWI 10 cases)were enrolled in our study with the average gestational age of 30.98±2.28 weeks and average birth weight was1266.02±178.63 g. Among them, the number of small for gestational age was 46. PNAC group owned 42 case,non-PNAC group owned 86 cases,the average duration of hospitalization of PNAC group was significantly longer than non-PNAC group.2.The incidence of PNAC was 32.81%,PNAC occurred about(28.14±15.53)days after beginning PN,the maximum direct bilirubin was(81.24±49.44)umol/L,Of the PNAC patients,45.2%(19/42)suffered from hepatic injury. The severity of PNAC(the maximum direct bilirubin) was directly proportional to the length of PN.3. Univariate analysis showed that PNAC was associated with the pregnancy with the pregnancy with hypothyroidism,anemia,sepsis,the average fast time,the duration of PN,the total time of fat emulsion,maximum amino acid(AA), the total calories at the end of second week, Logistic regression analysis further found that the pregnancy with hypothyroidism and the total time of lipid are risk factors,while the the total calories at the end of second week is a protective factor.4.The incidence of PNAC in carnitine treatment group(31%) was slightly lower than control group(33%),though the difference was no statistically significant between them,moreover,there was no drug adverse reaction in carnitine treatment group.5.There were 7 death cases in PNAC group,the others improved and discharged which all had good clinical recovery resulted except one missed, only 3 cases recovered for more than 3 months.Conclusion:The incidence of Long-term PNAC in VLBWI/ELBWI is high in our hospital,always with hepatic injury and longer duration of hospitalization. There were many factors evolved in PNAC infants, the risk factors were pregnancy with hypothyroidism and the total time of fat emulsion.We need to enhance health care of the perinatal period,reduce birth rate of VLBWI/ELBWI,choose enteral feeding as early as possible,seek for more suitable PN formula.