Teng Jonas, Arnell Henrik, Bohlin Kajsa, Nemeth Antal, Fischler Björn
Pediatric Unit, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
J Pediatr Gastroenterol Nutr. 2015 Jun;60(6):702-7. doi: 10.1097/MPG.0000000000000739.
Parenteral nutrition-associated liver disease (PNALD) is frequently detected in neonatal intensive care units. Parenteral lipid emulsion (PLE) content has been implicated in its pathogenesis. We aimed to study the effect on incidence and outcome of PNALD by replacing soy-based PLE with olive oil-based PLE in a population-based group of preterm infants.
All infants in Stockholm County with gestational age (GA) <30 weeks were included (n = 615). Infants who died before 28 days of age or were referred to or from other regions were excluded (n = 97). PNALD was defined as conjugated serum bilirubin ≥ 30 μmol/L and exceeding 20% of the total fraction on at least 2 occasions. Two different 2-year time periods were compared: before (SOY period) and after (OLIVE period) switching PLE. For each PNALD case, 2 GA-matched controls were randomly identified.
PNALD incidence was 14.8% (37/250) in the SOY period and 12.7% (34/268) in the OLIVE period (P = 0.52). The OLIVE infants with PNALD had more risk factors, such as lower GA and longer periods of parenteral nutrition, for developing PNALD than the SOY infants. Nevertheless, treatment during the SOY period was an independent risk factor for PNALD in logistic regression analysis.
Population-based incidence of PNALD is 1 of 7 in preterm infants with GA < 30 weeks. Changing from soy oil to olive oil-based PLE did not decrease the incidence of PNALD significantly. Olive oil-based PLE carries an equal or slightly decreased risk to develop PNALD compared with soy oil-based PLE.
肠外营养相关肝病（PNALD）在新生儿重症监护病房中经常被检测到。肠外脂质乳剂（PLE）的成分与该病的发病机制有关。我们旨在研究在以人群为基础的早产儿组中，用橄榄油基PLE替代大豆基PLE对PNALD发病率和结局的影响。
纳入斯德哥尔摩县所有孕周（GA）<30周的婴儿（n = 615）。排除28天龄前死亡或转诊至其他地区或从其他地区转诊来的婴儿（n = 97）。PNALD定义为血清结合胆红素≥30 μmol/L且至少2次超过总胆红素分数的20%。比较了两个不同的2年时间段：更换PLE之前（大豆期）和之后（橄榄油期）。对于每例PNALD病例，随机确定2例GA匹配的对照。
大豆期PNALD发病率为14.8%（37/250），橄榄油期为12.7%（34/268）（P = 0.52）。患有PNALD的橄榄油期婴儿比大豆期婴儿有更多的危险因素，如更低的GA和更长的肠外营养时间。然而，在逻辑回归分析中，大豆期的治疗是PNALD的一个独立危险因素。
在GA<30周的早产儿中，以人群为基础的PNALD发病率为七分之一。从大豆油基PLE改为橄榄油基PLE并没有显著降低PNALD的发病率。与大豆油基PLE相比，橄榄油基PLE发生PNALD的风险相同或略有降低。
