Service de Néonatologie, Hôpital Armand Trousseau, APHP, Université Pierre et Marie Curie, Paris, France.
J Pediatr Gastroenterol Nutr. 2012 Nov;55(5):592-8. doi: 10.1097/MPG.0b013e3182616916.
To describe the incidence and the characteristics of neonatal cholestasis in a cohort of patients with known risk factors and to investigate additional risk factors.
A prospective observational study conducted between April 2008 and 2009 involved all neonates admitted in the neonatal ward. They were divided into high- and low-risk groups for cholestasis. The high-risk group included preterm birth <34 weeks of gestation, small for gestational age (SGA), parenteral nutrition (PN) >7 days, abdomino-pelvic or thoracic surgery. Bilirubinemia was weekly measured in the high-risk group.
Of the 460 newborns studied, 234 were included in the high-risk group and 226 in the low-risk group. Cholestasis developed in 32 patients (13.7%) in the high-risk group at mean (SD) age of 14.7 (12.9) days; all were receiving PN. None of the patients in the low-risk group developed cholestasis. An analysis was carried out in the 207 patients in the high-risk group who received PN. The odds ratio (OR) for developing cholestasis was 2.3 [1.1-5.0] and 5.6 [2.5-12.5] for SGA or surgical patients, respectively. Cholestasis was associated with neonatal severe conditions, longer PN duration, and more intravenous macronutrients' intakes. In multivariate analysis, SGA and neonatal surgery were strong independent risk factors for cholestasis, with OR (95% confidence interval [95% CI]) of 4.4 [1.6-12.5] and 4.6 [1.7-12.3], respectively.
Transient neonatal cholestasis is a complication of PN. SGA and neonatal surgery are additional risk factors. There is no evidence to limit intravenous protein intakes in preterm.
描述已知危险因素的患者队列中新生儿胆汁淤积的发生率和特征，并探讨其他危险因素。
一项前瞻性观察研究于 2008 年 4 月至 2009 年进行，涉及所有入住新生儿病房的新生儿。他们被分为胆汁淤积高风险组和低风险组。高风险组包括早产（<34 周）、小于胎龄儿（SGA）、肠外营养（PN）>7 天、腹部-骨盆或胸部手术。高危组每周测量胆红素血症。
在研究的 460 名新生儿中，234 名被纳入高风险组，226 名被纳入低风险组。高风险组中 32 名（13.7%）患者在平均（SD）14.7（12.9）天龄时发生胆汁淤积，均接受 PN 治疗。低风险组无患者发生胆汁淤积。对接受 PN 的 207 名高风险组患者进行了分析。发生胆汁淤积的优势比（OR）分别为 2.3（1.1-5.0）和 5.6（2.5-12.5），对于 SGA 或手术患者。胆汁淤积与新生儿严重情况、PN 持续时间较长和静脉内大量营养素摄入较多有关。在多变量分析中，SGA 和新生儿手术是胆汁淤积的强独立危险因素，OR（95%置信区间[95%CI]）分别为 4.4（1.6-12.5）和 4.6（1.7-12.3）。
新生儿暂时性胆汁淤积是 PN 的并发症。SGA 和新生儿手术是额外的危险因素。早产儿静脉内蛋白质摄入无证据限制。
