Ginn-Pease M E, Pantalos D, King D R
J Pediatr Surg. 1985 Aug;20(4):436-9. doi: 10.1016/s0022-3468(85)80236-0.
TPN-associated cholestasis (TPNAC) is a common problem in neonatal surgical patients. Of the 222 infants admitted to the neonatal surgical intensive care unit between January 1982 and June 1983, 46 patients received parenteral nutrition for over 14 days. Cholestasis occurred in 16 of these patients (35%), while 30 patients remained jaundice-free. Clinical characteristics associated with the development of TPNAC, included primary diagnosis, low birth weight, duration of TPN administration, the interval before enteral feeding was initiated, sepsis, central venous catheter infection, and the number of operative procedures. Factors which did not appear significant in the development of conjugated hyperbilirubinemia were prematurity, sex, gestational age, average daily weight gain, and the specific components of the nutritional intake. Mortality was high in the children with cholestasis (31%) as compared to the "normal" neonates (3%) and two of the five deaths were directly related to progressive hepatic dysfunction. This report confirms the high incidence of TPNAC in the newborn surgical population and discusses the critical risk factors associated with development of the syndrome.
全胃肠外营养相关性胆汁淤积（TPNAC）是新生儿外科患者中常见的问题。在1982年1月至1983年6月期间入住新生儿外科重症监护病房的222例婴儿中，46例接受了超过14天的肠外营养。其中16例患者（35%）发生了胆汁淤积，而30例患者未出现黄疸。与TPNAC发生相关的临床特征包括初始诊断、低出生体重、TPN使用时长、开始肠内喂养前的间隔时间、败血症、中心静脉导管感染以及手术操作次数。在结合胆红素血症发生过程中未表现出显著影响的因素有早产、性别、胎龄、平均每日体重增加以及营养摄入的具体成分。与“正常”新生儿（3%）相比，胆汁淤积患儿的死亡率较高（31%），5例死亡中有2例与进行性肝功能障碍直接相关。本报告证实了新生儿外科人群中TPNAC的高发病率，并讨论了与该综合征发生相关的关键危险因素。
