Incidence of Parenteral Nutrition-Associated Liver Disease in Infants on Prolonged Parenteral Nutrition with a Soybean-Based Lipid Emulsion: A 7-Year Experience

作     者：Catherine M. Crill Oscar R. Herrera Lindsay H. Stuart Michael L. Christensen Catherine M. Crill;Oscar R. Herrera;Lindsay H. Stuart;Michael L. Christensen

作者机构：Department of Clinical Pharmacy and Translational Science University of Tennessee Health Science Center Memphis Tennessee USA Pharmacy Department Le Bonheur Children’s Hospital Memphis Tennessee USA Department of Pediatrics University of Tennessee Health Science Center Memphis Tennessee USA 

出 版 物：《Food and Nutrition Sciences》 (食品与营养科学（英文）)

年 卷 期：2020年第11卷第10期

页      面：899-910页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Parenteral Nutrition Infants Lipid Emulsions Liver Disease Cholestasis 

摘      要：Parenteral nutrition associated liver disease (PNALD) is a significant complication in infants receiving long-term parenteral nutrition (PN). Chronic administration of PN has been associated with its development. Our purpose is to characterize our incidence of PNALD over an extended period and identify risk factors for its development, including administration of soybean-based injectable lipid emulsions (ILEs) as we transit to novel ILEs in our practice. Infants receiving 30 days or more of PN were included. PNALD was defined as a direct bilirubin ≥ 2 mg/dL. Data collected included: patient demographics, clinical and enteral feeding characteristics. Macronutrient intake was recorded using these cut-offs: glucose infusion rate (GIR) of ≤14 mg/kg/min or above, protein doses of ≤3 g/kg/day or above and lipid doses of ≤2 g/kg/day or above.A total of 349 infants were included, with an annual incidence of PNALD ranging between 34% -54%. Infants with PNALD were younger by gestation (27 vs. 29.5 weeks) and smaller by birthweight (900 vs. 1248 grams). Sepsis, GI disease including necrotizing enterocolitis and bowel resection were significantly associated with an increased risk for development of PNALD. PNALD infants received lower protein doses (3.0 vs 3.3 g/kg/day, p = 0.014) while receiving higher GIR (11.4 vs 10.7 mg/kg/min, p = 0.012) compared to non-PNALD infants. Low birth weight, sepsis and bowel resection remain strong indicators of risk for PNALD. No single macronutrient increased our infants’ risk for PNALD. The use of newer ILEs when available should be evaluated for their impact on PNALD development.