| Objective:The aim is to investigate the clinical features and risk factors of parenteral nutrition-associated cholestasis（PNAC）in low birth weight infants,analyze the dynamic changes of various indicators of hepatic function in preterm infants with PNAC and hepatic function damage,providing valuable clues for clinical diagnosis and treatment,and reducing serious complications as well.Methods:The medical records of 114 low birth weight infants admitted to the neonatal intensive care unit（NICU）in our hospital from 2018 to 2020 were reviewed.Inclusion criteria:gestational age<37 weeks;birth weight<2500g;received parenteral nutrition（PN）≥14 days;Hepatic function was normal at the beginning of PN.Exclusion criteria:the cholestasis attributable to anatomic obstruction of the hepatobiliary tact,congenital infection,inherited metabolic disorders.According to the direct bilirubin（DB）>34μmol/L（2mg/dl）,it was divided into PNAC group（27 cases）and non-PNAC group（87 cases）.Alanine aminotransferase>50U/L was defined as hepatic function damage.Parenteral nutrition methods:All premature from 24 to 72 hours after birth was feed through mouth,who intolerance oral feeding or oral feeding is inadequate,given PN.The starting quantity of liquid was 80～100ml?kg-1?d-1,the daily increase of 10～20ml?kg-1?d-1,until 120～160ml?kg-1?d-1.The glucose was initiated on the first day,with the dose of 4～8mg?kg-1?min-1and advanced to maximum of 11～14mg?kg-1?min-1when needed.6%amino acid solution was given in the first 24 hours of life.The starting dose of amino acid was 1.5～2.0g?kg-1?d-1,and increased by 0.5g?kg-1?d-1until 3.5～4.0g?kg-1?d-1.20%lipid solution was given in the second day.The starting dose was1.0g?kg-1?d-1,and increased by 0.5～1.0g?kg-1?d-1until 3.0g?kg-1?d-1.Hepatic function was checked at weekly intervals to monitor for PN complications.Compared the birth situation,hospitalization diseases,clinical treatment and hepatic function examination results between two groups.Among them,the birth situation includes mode of delivery,gender,gestational age,and birth weight;Hospitalization diseases includes pneumonia,respiratory distress syndrome,sepsis,necrotizing enterocolitis,intracranial hemorrhage and hypothyroidism;Clinical treatment includes hospital stays,antibiotic therapy days,mechanical ventilation time,age of starting feeding,the duration of PN exposure,fasting time and formulation of PN.Patients in PNAC group were followed up and their prognosis was evaluated.Result:The incidence of PNAC was 23.6%,PNAC occurred（32.8?12.5）d after PN,and recovered in（52.2±29.5）d after PN.Among PNAC infants,14 cases（51.8%）suffered from hepatic function damage,hepatic function damage occurred（42.0?14.7）d after PN,lagging behind the occurrence of cholestasis.The duration of hepatic function damage was shorter than that of cholestasis,which lasted（78.2±39.3）d.DB lasted（90.2±42）d.Total bile acid（TBA）andγ-glutamyl transpeptidase（γ-GT）recovered at the latest,lasted for（108.4?45.9）d and（103.6?46.5）d separately.Compared with non-PNAC group,hospital stays,antibiotic therapy days,mechanical ventilation time,the duration of PN exposure,fasting time of PNAC group was longer,age of starting feeding of PNAC group was later,cumulative dose of acid and lipids of PNAC was larger than non-PNAC.The proportion of necrotizing enterocolitis（NEC）and sepsis of PNAC group was larger than non-PNAC group（P<0.05）.Multivariate logistic regression analysis showed that the length duration of fasting time,the duration of PN exposure,and NEC were the independent risk factors of PNAC:Fasting time was positively correlated with PNAC;The longer the PN application time,the higher incidence of PNAC;Preterm infants with NEC suffered higher incidence of PNAC comparing with preterm infants without NEC.Conclusion:PNAC is a common complication of PN in preterm infants,the risk factors were NEC,the fasting time and the duration of PN.After the occurrence of PNAC,hepatobiliary treatment can make good clinical prognosis. |
