Retrospective Dual‐Center Study of Parenteral Nutrition–Associated Cholestasis in Premature Neonates: 15 Years' Experience

Yan, Wei; Hong, Li; Wang, Ying; Feng, Yi; Lu, Lina; Tao, Yijing; Wu, Jiang; Ruan, Han‐Li; Tang, Qingya; Cai, Wei

doi:10.1177/0884533616687532

Cited by 18 publications

(22 citation statements)

References 31 publications

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“…Septicemias from PN catheter infections and intestinal bacterial translocation are very common among NEC patients with PN [17]. The association between septicemias and IFAC has been also reported by other studies [15,18]. In concordance with two previous studies by Duro D. et al and Elfvin A. et al [9,15], we found no association between gestational age and IFAC.…”

Section: Discussionsupporting

confidence: 92%

“…Contrary to the study by Duro et al [9] we did not find preoperative PN a risk factor for IFAC. This is probably because the duration of preoperative PN in our patients was short compared with the study by Duro et al We found that birth weight, relative loss of small intestine, loss of ileocecal valve, length of PN, start of EN and NEC remained significant factors in [18] reported 5% incidence of cholestasis among 1074 nonsurgical premature neonates with prolonged (over 43 days) PN, and male sex and septicemia were found as the main risk factors for of cholestasis. The adoption of alternative lipid emulsions has not been shown to change the incidence and outcome of IFAC [19].…”

Section: Discussioncontrasting

confidence: 46%

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Intestinal failure associated cholestasis in surgical necrotizing enterocolitis and spontaneous intestinal perforation

Karila

Anttila

Iber

et al. 2019

Journal of Pediatric Surgery

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a b s t r a c tBackground: Surgery for necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) is often complicated by intestinal failure (IF) and intestinal failure associated cholestasis (IFAC). Objective: Assessment of incidence, predictors, and mortality associated with IFAC in surgically treated NEC and SIP. Methods: A retrospective observational study based on hospital records during 1986-2014 in the two largest Finnish neonatal intensive care units was performed. IFAC was defined as conjugated bilirubin N 34 μmol/l (2.0 mg/dl) for ≥ two postoperative weeks while receiving parenteral nutrition (PN). Results: In total 225 patients underwent surgery for NEC (n = 142; 63%) or SIP (n = 83; 37%). Included were 57 survivors with ≥two weeks PN. Sixty-five (42%) patients developed IFAC. Two-year survival with IFAC was 80% and without IFAC 89% (p = 0.13). Of the 65 patients with IFAC, all eight with unresolved IFAC died in comparison to six of 57 (11%) whose IFAC resolved (p b 0.0001), while IFAC resolved in all survivors. Survival among patients with resolved IFAC was 89% and with unresolved IFAC (n = 8) 0%, (p b 0.0001). IFAC lasted for median 83 (IQR 45-120) days and correlated with the duration of PN (R2 = 0.16, p = 0.03), delay of starting enteral feeds (R2 = 0.12, p = 0.05) and PN lipid emulsion (RR = 1.0 (95% CI = 1.0-1.1) (p = 0.02). In multivariate logistic regression analysis, IFAC development associated with septicemias and reoperations. Conclusions: 42% of prematures who underwent surgery for NEC or SIP developed IFAC. Reoperations and septicemias increased the risk of IFAC. None of the patients with unresolved IFAC survived, but IFAC did not increase overall mortality. Type of study: Retrospective prognosis study. Level of evidence: Level II.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 46%

Intestinal failure associated cholestasis in surgical necrotizing enterocolitis and spontaneous intestinal perforation

Karila

Anttila

Iber

et al. 2019

Journal of Pediatric Surgery

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“…25 In later studies, increased PN durations were shown by multivariate logistic regression to be an independent risk factor for PNAC. 9,15,17,21 In this study, prolonged duration of PN (≥43 days) was an independent risk factor in accordance with previous research. 9,15,17,19,21,25 If the duration of PN can be shortened, the incidence of PNAC in VLBW infants may decrease.…”

Section: Incidence Of Pnacsupporting

confidence: 92%

“…3 A retrospective study of 1074 premature neonates without surgery reported the incidence to be 4.93, 6.8 and 20.0% in all preterm infants, VLBW infants and extremely low birthweight (ELBW) infants, respectively. 9 In this study, the incidence was 6.7% and decreased from 9.4% (group A) to 6.3% (group B) over the past few decades. This result was substantially lower than previous studies, which could be explained by several reasons.…”

Section: Incidence Of Pnacmentioning

confidence: 46%

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Risk factors of parenteral nutrition‐associated cholestasis in very‐low‐birthweight infants

Wang

Yan

Hong

et al. 2020

J Paediatrics Child Health

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Aim: We aimed to explore risk factors associated with parenteral nutrition-associated cholestasis (PNAC) in very-low-birthweight (VLBW) infants. Methods: VLBW infants receiving parenteral nutrition (PN) for at least 14 days were enrolled in a retrospective dual-centre study and divided into two groups chronologically: group A (2000-2007) and group B (2008-2015). The incidence of PNAC and related factors were investigated. We compared the differences between PNAC and non-PNAC groups. A multivariate binary logistic regression analysis was carried out to identify the potential risk factors of PNAC. Results: A total of 387 VLBW infants (53 in group A and 334 in group B) were enrolled in the study. The total incidence of PNAC was 6.7%, 9.4% in group A and 6.3% in group B. The dosage of amino acid (P = 0.009), glucose (P = 0.006), PN calories (P = 0.021) and the ratio of glucose/fat (P = 0.014) were significantly higher in group B than in group A. Non-protein energy to nitrogen ratio (P = 0.017) was lower in group B. Birthweight was significantly lower in the PNAC group than in the non-PNAC group (P = 0.021). Subgroup analysis showed that gestational age and duration of PN were significantly different between the PNAC and non-PNAC groups (P < 0.05). Logistic regression showed that prolonged duration of PN (≥43 days) (odds ratio 3.155, 95% confidence interval 1.009-9.861, P = 0.048) was an independent risk factor of PNAC. Conclusions: For VLBW infants, prolonged duration of PN is a risk factor for the development of PNAC. PNAC may be prevented by weaning off PN as early as possible in VLBW infants.

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Targeted LC-MS/MS profiling of bile acids reveals primary/secondary bile acid ratio as a novel biomarker for necrotizing enterocolitis

Gao,

Hu,

et al. 2023

Anal Bioanal Chem

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Bile acids (BAs) are involved in the development of necrotizing enterocolitis (NEC), which mainly occurs in preterm infants. We aim to identify the change of BAs in preterm infants and validate its potential value in the detection of NEC. Targeted liquid chromatography–tandem mass spectrometry (LC-MS/MS) was performed to measure the plasma BAs in healthy preterm infants and patients with NEC. By analyzing the level of BAs in healthy preterm infants, we found that the plasma concentrations of BAs were related to sex, gestational/postnatal age, birth weight, mode of birth, and feeding type after birth. The plasma levels of TCA, GCA, TCDCA, GCDCA, primary BAs, and total BAs and the primary/secondary BA ratio were decreased, while DCA, UDCA, and secondary BAs were increased in NEC. The primary/secondary BA ratio (cutoff point 62.9) can effectively differentiate NEC from healthy preterm infants, with an AUC of 0.9, a sensitivity of 94.5%, and a specificity of 78.1%. Combining the ratio with high-risk factors of NEC can better distinguish between NEC and control, with an AUC of 0.95. Importantly, significantly lower levels of primary/secondary BA ratio were found in infants with surgical NEC than in nonsurgical NEC cases. The cutoff point of 28.7 identified surgical NEC from nonsurgical NEC with sensitivity and specificity of 76.9% and 100%. Thus, our study identified that the primary/secondary BA ratio in the plasma can differentiate NEC from healthy preterm infants and effectively differentiate the surgical NEC from nonsurgical NEC. Therefore, LC-MS/MS was expected to be a novel measurement platform used to distinguish infants who are most in need of close monitoring or early surgical intervention.

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Retrospective Dual‐Center Study of Parenteral Nutrition–Associated Cholestasis in Premature Neonates: 15 Years' Experience

Abstract: Prolonged duration (≥43 days), male sex, and sepsis are probably independent risk factors for developing PNAC in premature neonates.

Cited by 18 publications

References 31 publications

Intestinal failure associated cholestasis in surgical necrotizing enterocolitis and spontaneous intestinal perforation

Intestinal failure associated cholestasis in surgical necrotizing enterocolitis and spontaneous intestinal perforation

Risk factors of parenteral nutrition‐associated cholestasis in very‐low‐birthweight infants

Targeted LC-MS/MS profiling of bile acids reveals primary/secondary bile acid ratio as a novel biomarker for necrotizing enterocolitis

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