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Analysis of risk factors for parenteral nutrition-associated cholestasis in preterm infants: a multicenter observational study

BACKGROUND: It is proposed that the development of parenteral nutrition-associated cholestasis (PNAC) was significantly associated with preterm birth, low birth weight, infection, etc.; however, the etiology and pathogenesis of PNAC are not fully understood. Most of the studies examining PNAC-associ...

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Autores principales: Wang, Ya-sen, Shen, Wei, Yang, Qing, Lin, Rong, Tang, Li-xia, Bai, Rui-miao, Yang, Dong, Zhang, Juan, Zhang, Yi-jia, Yu, Wen-ting, Song, Shi-rong, Kong, Juan, Song, Si-yu, Mao, Jian, Tong, Xiao-mei, Li, Zhan-kui, Wu, Fan, Lin, Xin-zhu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10199576/
https://www.ncbi.nlm.nih.gov/pubmed/37210514
http://dx.doi.org/10.1186/s12887-023-04068-0
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author Wang, Ya-sen
Shen, Wei
Yang, Qing
Lin, Rong
Tang, Li-xia
Bai, Rui-miao
Yang, Dong
Zhang, Juan
Zhang, Yi-jia
Yu, Wen-ting
Song, Shi-rong
Kong, Juan
Song, Si-yu
Mao, Jian
Tong, Xiao-mei
Li, Zhan-kui
Wu, Fan
Lin, Xin-zhu
author_facet Wang, Ya-sen
Shen, Wei
Yang, Qing
Lin, Rong
Tang, Li-xia
Bai, Rui-miao
Yang, Dong
Zhang, Juan
Zhang, Yi-jia
Yu, Wen-ting
Song, Shi-rong
Kong, Juan
Song, Si-yu
Mao, Jian
Tong, Xiao-mei
Li, Zhan-kui
Wu, Fan
Lin, Xin-zhu
author_sort Wang, Ya-sen
collection PubMed
description BACKGROUND: It is proposed that the development of parenteral nutrition-associated cholestasis (PNAC) was significantly associated with preterm birth, low birth weight, infection, etc.; however, the etiology and pathogenesis of PNAC are not fully understood. Most of the studies examining PNAC-associated risk factors were single-center studies with relatively small sample sizes. OBJECTIVE: To analyze the risk factors associated with PNAC in preterm infants in China. METHODS: This is a retrospective multicenter observational study. Clinical data on the effect of multiple oil-fat emulsions (soybean oil-medium chain triglycerides-olive oil-fish oil, SMOF) in preterm infants were collected from a prospective multicenter randomized controlled study. A secondary analysis was performed in which preterm infants were divided into the PNAC group and the non-PNAC group based on the PNAC status. RESULTS: A total of 465 cases very preterm infants or very low birth weight infants were included in the study in which 81 cases were assigned to the PNAC group and 384 cases were assigned to the non-PNAC group. The PNAC group had a lower mean gestational age, lower mean birth weight, longer duration of invasive and non-invasive mechanical ventilation, a longer duration oxygen support, and longer hospital stay (P < 0.001 for all). The PNAC group had higher respiratory distress syndrome, hemodynamically significant patent ductus arteriosus, necrotizing enterocolitis (NEC) with stage II or higher, surgically treated NEC, late-onset sepsis, metabolic bone disease, and extrauterine growth retardation (EUGR) compared to the non-PNAC group (P < 0.05 for all). In contrast with the non-PNAC group, the PNAC group received a higher maximum dose of amino acids and fat emulsion, more medium/long-chain fatty emulsion, less SMOF, had a longer duration of parenteral nutrition, lower rates of breastfeeding, higher incidence of feeding intolerance (FI), more accumulated days to achieve total enteral nutrition, less accumulated days of total calories up to standard 110 kcal/kg/day and slower velocity of weight growth (P < 0.05 for all). Logistic regression analysis indicated that the maximum dose of amino acids (OR, 5.352; 95% CI, 2.355 to 12.161), EUGR (OR, 2.396; 95% CI, 1.255 to 4.572), FI (OR, 2.581; 95% CI, 1.395 to 4.775), surgically treated NEC (OR, 11.300; 95% CI, 2.127 ~ 60.035), and longer total hospital stay (OR, 1.030; 95% CI, 1.014 to 1.046) were independent risk factors for the development of PNAC. SMOF (OR, 0.358; 95% CI, 0.193 to 0.663) and breastfeeding (OR, 0.297; 95% CI, 0.157 to 0.559) were protective factors for PNAC. CONCLUSIONS: PNAC can be reduced by optimizing the management of enteral and parenteral nutrition and reducing gastrointestinal comorbidities in preterm infants.
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spelling pubmed-101995762023-05-21 Analysis of risk factors for parenteral nutrition-associated cholestasis in preterm infants: a multicenter observational study Wang, Ya-sen Shen, Wei Yang, Qing Lin, Rong Tang, Li-xia Bai, Rui-miao Yang, Dong Zhang, Juan Zhang, Yi-jia Yu, Wen-ting Song, Shi-rong Kong, Juan Song, Si-yu Mao, Jian Tong, Xiao-mei Li, Zhan-kui Wu, Fan Lin, Xin-zhu BMC Pediatr Research BACKGROUND: It is proposed that the development of parenteral nutrition-associated cholestasis (PNAC) was significantly associated with preterm birth, low birth weight, infection, etc.; however, the etiology and pathogenesis of PNAC are not fully understood. Most of the studies examining PNAC-associated risk factors were single-center studies with relatively small sample sizes. OBJECTIVE: To analyze the risk factors associated with PNAC in preterm infants in China. METHODS: This is a retrospective multicenter observational study. Clinical data on the effect of multiple oil-fat emulsions (soybean oil-medium chain triglycerides-olive oil-fish oil, SMOF) in preterm infants were collected from a prospective multicenter randomized controlled study. A secondary analysis was performed in which preterm infants were divided into the PNAC group and the non-PNAC group based on the PNAC status. RESULTS: A total of 465 cases very preterm infants or very low birth weight infants were included in the study in which 81 cases were assigned to the PNAC group and 384 cases were assigned to the non-PNAC group. The PNAC group had a lower mean gestational age, lower mean birth weight, longer duration of invasive and non-invasive mechanical ventilation, a longer duration oxygen support, and longer hospital stay (P < 0.001 for all). The PNAC group had higher respiratory distress syndrome, hemodynamically significant patent ductus arteriosus, necrotizing enterocolitis (NEC) with stage II or higher, surgically treated NEC, late-onset sepsis, metabolic bone disease, and extrauterine growth retardation (EUGR) compared to the non-PNAC group (P < 0.05 for all). In contrast with the non-PNAC group, the PNAC group received a higher maximum dose of amino acids and fat emulsion, more medium/long-chain fatty emulsion, less SMOF, had a longer duration of parenteral nutrition, lower rates of breastfeeding, higher incidence of feeding intolerance (FI), more accumulated days to achieve total enteral nutrition, less accumulated days of total calories up to standard 110 kcal/kg/day and slower velocity of weight growth (P < 0.05 for all). Logistic regression analysis indicated that the maximum dose of amino acids (OR, 5.352; 95% CI, 2.355 to 12.161), EUGR (OR, 2.396; 95% CI, 1.255 to 4.572), FI (OR, 2.581; 95% CI, 1.395 to 4.775), surgically treated NEC (OR, 11.300; 95% CI, 2.127 ~ 60.035), and longer total hospital stay (OR, 1.030; 95% CI, 1.014 to 1.046) were independent risk factors for the development of PNAC. SMOF (OR, 0.358; 95% CI, 0.193 to 0.663) and breastfeeding (OR, 0.297; 95% CI, 0.157 to 0.559) were protective factors for PNAC. CONCLUSIONS: PNAC can be reduced by optimizing the management of enteral and parenteral nutrition and reducing gastrointestinal comorbidities in preterm infants. BioMed Central 2023-05-20 /pmc/articles/PMC10199576/ /pubmed/37210514 http://dx.doi.org/10.1186/s12887-023-04068-0 Text en © The Author(s) 2023, corrected publication 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Wang, Ya-sen
Shen, Wei
Yang, Qing
Lin, Rong
Tang, Li-xia
Bai, Rui-miao
Yang, Dong
Zhang, Juan
Zhang, Yi-jia
Yu, Wen-ting
Song, Shi-rong
Kong, Juan
Song, Si-yu
Mao, Jian
Tong, Xiao-mei
Li, Zhan-kui
Wu, Fan
Lin, Xin-zhu
Analysis of risk factors for parenteral nutrition-associated cholestasis in preterm infants: a multicenter observational study
title Analysis of risk factors for parenteral nutrition-associated cholestasis in preterm infants: a multicenter observational study
title_full Analysis of risk factors for parenteral nutrition-associated cholestasis in preterm infants: a multicenter observational study
title_fullStr Analysis of risk factors for parenteral nutrition-associated cholestasis in preterm infants: a multicenter observational study
title_full_unstemmed Analysis of risk factors for parenteral nutrition-associated cholestasis in preterm infants: a multicenter observational study
title_short Analysis of risk factors for parenteral nutrition-associated cholestasis in preterm infants: a multicenter observational study
title_sort analysis of risk factors for parenteral nutrition-associated cholestasis in preterm infants: a multicenter observational study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10199576/
https://www.ncbi.nlm.nih.gov/pubmed/37210514
http://dx.doi.org/10.1186/s12887-023-04068-0
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