Clinical analysis of preterm infants parenteral nutrition associated cholestasis
10.3760/cma.j.issn.1673-4408.2017.04.017
- VernacularTitle:早产儿胃肠外营养相关性胆汁淤积症临床研究
- Author:
Shirong SONG
;
Jie WU
- Keywords:
Preterm infants;
Cholestasis;
Parenteral nutrition;
Liver dysfunction
- From:
International Journal of Pediatrics
2017;44(4):286-290
- CountryChina
- Language:Chinese
-
Abstract:
Objective To discuss the clinical feature of cholestasis preterm infants who have used parenteral nutrition early after birth,and analyze the relative factors and preventive meatures of parenteral nutrition associated cholestasis (PNAC).Methods We retrospectively analyzed the preterm infants who were born and hospitalized at Shengjing Hospital of China Medical University from January,2011 to April,2016.There were 89 cases in total that used at least 2 weeks of parenteral nutrition in the early stage after birth and were developed to cholestasis afterwards.We divided 89 cases into PNAC group and multifactor group:the former was corresponded to PNAC diagnosis standards,accounting for41 cases (46.07％);the latter with other etiology in addition to parenteral nutrition accounts for 48 cases.The clinical characteristics were studied and analyzed using case-control method.Results The sex ratio of premature cholestasis was 2.18:1,the mean gestational age was (31.05 ±2.15) weeks,the mean birth weight was (1360.55 ±421.14) g,and the mean using-time of parenteral nutrition was (26.22 ± 9.78) d.Futhermore,PNAC group was divided into hepatitis group and non-hepatitis group according to the alanine aminotransferase level,and they both had statistical significance in gestational age,starting time of parenteral nutrition,appearance time of jaundice,enteral feeding time,starting dose of amino acid,maximum dose of fat emulsion (P ＜ 0.05).We divided them into long-term group (≥20 d) and short-term group (＜ 20 d) according to the using time of parenteral nutrition.The level of alanine aminotransferase,glutamic oxalacetic transaminase,total bilirubin,direct bilirubin and bile acid of longterm group was higher than those of short-term group,but with P≥0.05.The multifactor group was mostly accompanied with multiple infections in the order of bacterial infection (75.0％),fungal infection (20.83％),cytomegalovirus infection (8.33％) and syphilis infection (2.08％),etc.The other complication's incidence rate of PNAC group and multifactor group had no statistical significance.In terms of prognosis,the liver function of two group improved remarkably than before,with PNAC group having more significance (P ＜0.05).Conclusion PNAC is the major factor of preterm cholestasis,and the degree of liver damage of PNAC preterm was related to starting time of parenteral nutrition,using time of parenteral nutrition,enteral feeding time,starting dose of amino acid and maximum dose of fat emulsion.The liver function of PNAC group is recovered obviously through regulatory treatment,and it possesses a better prognosis than multifactorgroup.
