极低出生体重儿肠外营养相关性胆汁淤积：单中心经验

Parenteral Nutrition-Associated Cholestasis in Very Low Birth Weight Infants: A Single Center Experience.

作者信息

Kim Ah-Young, Lim Ryoung-Kyoung, Han Young-Mi, Park Kyung-Hee, Byun Shin-Yun

机构信息

Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea.

Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea.; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.

出版信息

Pediatr Gastroenterol Hepatol Nutr. 2016 Mar;19(1):61-70. doi: 10.5223/pghn.2016.19.1.61. Epub 2016 Mar 22.

DOI:10.5223/pghn.2016.19.1.61

PMID:27066450

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4821984/

Abstract

PURPOSE

Parenteral nutrition (PN)-associated cholestasis (PNAC) is one of the most common complications in very low birth weight infants (VLBWIs). The aim of this study is to evaluate the risk factors of PNAC in VBLWIs.

METHODS

We retrospectively reviewed the medical records of 322 VLBWIs admitted to the neonatal intensive care unit of our hospital from July 1, 2009 to December 31, 2013. We excluded 72 dead infants; 6 infants were transferred to another hospital, and 57 infants were transferred to our hospital at 2 weeks after birth. The infants were divided into the cholestasis and the non-cholestasis groups. PNAC was defined as a direct bilirubin level of ≥2.0 mg/dL in infants administered with PN for ≥2 weeks.

RESULTS

A total of 187 VLBWI were enrolled in this study; of these, 46 infants developed PNAC. Multivariate logistic regression analysis showed that the risk factors of PNAC in VLBWI were longer duration of antimicrobial use (odds ratio [OR] 4.49, 95% confidence interval [95% CI] 4.42-4.58), longer duration of PN (OR 2.68, 95% CI 2.41-3.00), long-term lack of enteral nutrition (OR 2.89, 95% CI 2.43-3.37), occurrence of necrotizing enterocolitis (OR 2.40, 95% CI 2.16-2.83), and gastrointestinal operation (OR 2.19, 95% CI 2.03-2.58).

CONCLUSION

The results of this study suggest that shorter PN, aggressive enteral nutrition, and appropriate antimicrobial use are important strategies in preventing PNAC.

摘要

目的

肠外营养（PN）相关胆汁淤积（PNAC）是极低出生体重儿（VLBWI）最常见的并发症之一。本研究旨在评估VLBWI发生PNAC的危险因素。

方法

我们回顾性分析了2009年7月1日至2013年12月31日在我院新生儿重症监护病房收治的322例VLBWI的病历。我们排除了72例死亡婴儿；6例婴儿转至其他医院，57例婴儿在出生2周后转至我院。将婴儿分为胆汁淤积组和非胆汁淤积组。PNAC定义为接受PN≥2周的婴儿直接胆红素水平≥2.0mg/dL。

结果

本研究共纳入187例VLBWI；其中，46例婴儿发生PNAC。多因素logistic回归分析显示，VLBWI发生PNAC的危险因素为抗菌药物使用时间较长（比值比[OR]4.49，95%置信区间[95%CI]4.42 - 4.58）、PN时间较长（OR 2.68，95%CI 2.41 - 3.00）、长期缺乏肠内营养（OR 2.89，95%CI 2.43 - 3.37）、坏死性小肠结肠炎的发生（OR 2.40，95%CI 2.16 - 2.83）以及胃肠道手术（OR 2.19，95%CI 2.03 - 2.58）。