Ma Xiaolei, Zhou Ying, Guo Yanting, Ye Li
Neonatal Department, Tianjin First Central Hospital, Tianjin, China.
Front Pediatr. 2025 Sep 11;13:1651046. doi: 10.3389/fped.2025.1651046. eCollection 2025.
Parenteral nutrition-associated cholestasis (PNAC) is common among very and extremely preterm infants (VPT). This study aims to investigate the relationship between the duration of parenteral nutrition (PN), enteral nutrition (EN), and the PN/EN ratio and the occurrence of PNAC in VPT, with the goal of providing a basis for the early identification of high-risk infants in clinical practice.
A total of 230 VPT were retrospectively enrolled and divided into two groups based on the occurrence of PNAC. Baseline characteristics such as gestational age, sex, and birth weight, as well as clinical features, were compared between groups. Multivariable logistic regression was used to analyze the association between the duration of enteral nutrition (EN), parenteral nutrition (PN), and the development of PNAC. Interaction effects between PN, EN, the PN/EN ratio, and clinical variables were also explored. Restricted cubic spline (RCS) regression was employed to assess potential nonlinear relationships between PN, EN duration, PN/EN ratio, and PNAC. Predictive performance was evaluated using the area under the receiver operating characteristic curve (AUC).
Infants in the PNAC group had significantly lower gestational age, birth weight, and Apgar scores compared to the non-PNAC group. In contrast, the incidence of premature rupture of membranes and mechanical ventilation was significantly higher. In VPT, longer PN duration, shorter EN duration, and a higher PN/EN ratio were significantly associated with increased risk of PNAC, showing linear or near-linear trends. ROC analysis indicated that the PN/EN ratio had better predictive performance for PNAC than either PN or EN duration alone. Interaction analysis revealed that the association between PN/EN and PNAC risk was stronger in infants with lower birth weight and lower 1-minute Apgar scores.
Longer PN duration, shorter EN duration, and a higher PN/EN ratio are significant risk factors for PNAC in VPT. The PN/EN ratio demonstrated the best predictive accuracy. The association between PN/EN and PNAC was more pronounced in infants with lower birth weight and lower 1-minute Apgar scores.
肠外营养相关胆汁淤积（PNAC）在极早产儿（VPT）中很常见。本研究旨在探讨肠外营养（PN）、肠内营养（EN）的持续时间以及PN/EN比值与VPT中PNAC发生之间的关系，以期为临床实践中早期识别高危婴儿提供依据。
回顾性纳入230例VPT，并根据是否发生PNAC分为两组。比较两组之间的基线特征，如胎龄、性别和出生体重，以及临床特征。采用多变量逻辑回归分析肠内营养（EN）、肠外营养（PN）持续时间与PNAC发生之间的关联。还探讨了PN、EN、PN/EN比值与临床变量之间的交互作用。采用限制立方样条（RCS）回归评估PN、EN持续时间、PN/EN比值与PNAC之间潜在的非线性关系。使用受试者操作特征曲线（AUC）下的面积评估预测性能。
与非PNAC组相比，PNAC组婴儿的胎龄、出生体重和阿氏评分显著更低。相反，胎膜早破和机械通气的发生率显著更高。在VPT中，较长的PN持续时间、较短的EN持续时间和较高的PN/EN比值与PNAC风险增加显著相关，呈线性或近似线性趋势。ROC分析表明，PN/EN比值对PNAC的预测性能优于单独的PN或EN持续时间。交互分析显示，出生体重较低和1分钟阿氏评分较低的婴儿中，PN/EN与PNAC风险之间的关联更强。
较长的PN持续时间、较短的EN持续时间和较高的PN/EN比值是VPT中PNAC的重要危险因素。PN/EN比值显示出最佳的预测准确性。PN/EN与PNAC之间的关联在出生体重较低和1分钟阿氏评分较低的婴儿中更为明显。
