Clauss Christie, Tack Valentyna, Macchiarulo Maria, Akerman Meredith, El-Chaar Gladys, Hanna Nazeeh, Tiozzo Caterina
Department of Pharmacy, NYU Langone Hospital-Long Island, Mineola, NY, United States.
Department of Neonatology, Children's National Hospital, Washington, DC, United States.
Front Pediatr. 2022 Aug 3;10:900068. doi: 10.3389/fped.2022.900068. eCollection 2022.
Parenteral Nutrition (PN) can lead to intestinal failure associated liver disease (IFALD). There are no human studies to date studying specifically the benefits of light-protection on neonatal IFALD. Recently, the European Medicines Agency and the American Society for Parenteral and Enteral Nutrition (ASPEN) both recommended full light protection of PN to reduce the risk of adverse clinical outcomes.
The primary objective of this study was to evaluate the impact of light-protecting PN on the incidence of cholestasis and peak direct bilirubin levels in premature infants.
Retrospective chart review of preterm infants requiring PN for a minimum of 2 weeks with or without light-protection. After light protection of the PN solution, primary outcomes (including cholestasis and direct bilirubin levels) of both groups were compared. Secondary outcomes include evaluation of bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), sepsis and mortality.
A total of 50 preterm infants <37 weeks gestation were included, 25 infants in each group. There was a statistically significant decrease in the rate of cholestasis (12 vs. 3, = 0.005), median peak direct bilirubin levels (1.7 vs. 0.9 mg/dL, p = 0.02) and total bilirubin levels (4.1 vs. 3.4, = 0.05) in the light-protection group compared to no light-protection group. There was a decrease in the incidence of severe BPD (with an increase of mild BPD, resulting in the same overall BPD rate) in the light-protection compared to no light-protection group (7 vs. 15, = 0.0223). There was no difference in NEC, ROP, sepsis or mortality.
Our study supports that the practice of light-protecting PN may reduce the incidence of IFALD in premature infants. Moreover, there was a trend toward decreased incidence of severe BPD in the light-protection group. Further light protection studies are needed to confirm these findings.
肠外营养（PN）可导致肠衰竭相关肝病（IFALD）。迄今为止，尚无人体研究专门探讨光照防护对新生儿IFALD的益处。最近，欧洲药品管理局和美国肠外与肠内营养学会（ASPEN）均建议对PN进行全面光照防护，以降低不良临床结局的风险。
本研究的主要目的是评估光照防护PN对早产儿胆汁淤积发生率和直接胆红素峰值水平的影响。
对需要PN至少2周的早产儿进行回顾性病历审查，分为有或无光照防护两组。对PN溶液进行光照防护后，比较两组的主要结局（包括胆汁淤积和直接胆红素水平）。次要结局包括评估支气管肺发育不良（BPD）、坏死性小肠结肠炎（NEC）、早产儿视网膜病变（ROP）、败血症和死亡率。
共纳入50例孕周<37周的早产儿，每组25例。与无光照防护组相比，光照防护组的胆汁淤积发生率（12例 vs. 3例，P = 0.005）、直接胆红素中位数峰值水平（1.7 mg/dL vs. 0.9 mg/dL，p = 0.02）和总胆红素水平（4.1 vs. 3.4，P = 0.05）均有统计学显著下降。与无光照防护组相比，光照防护组严重BPD的发生率降低（轻度BPD增加，但总体BPD发生率相同）（7例 vs. 15例，P = 0.0223）。NEC、ROP、败血症或死亡率方面无差异。
我们的研究支持光照防护PN的做法可能会降低早产儿IFALD的发生率。此外，光照防护组严重BPD的发生率有下降趋势。需要进一步的光照防护研究来证实这些发现。
