Risk Factors Of Parenteral Nutrition Associated Cholestasis In Preterm Infants

Objective:To analyze the risk factors of parenteral nutrition associated cholestasis(PNAC)in preterm infants,so as to provide basis for reducing the occurrence of PNAC in the future,which is conducive to early detection,early diagnosis,early prevention and early treatment.Methods:1.A retrospective analysis of 344 premature infants who were admitted to the neonatal intensive care unit of our hospital within 24 hours after birth from January2016 to August 2021 and received parenteral venous nutrition ≥ 14 d,gestational age< 37 weeks and weight < 2000 g were taken as the research objects.Those with PNAC were the case group and those without PNAC were the control group.All children were clear about the basic diseases:Neonatal respiratory distress syndrome(NRDS),neonatal hypoxic ischemic encephalopathy(HIE),neonatal asphyxia,neonatal anemia,apnea,patent ductus arteriosus,respiratory failure,neonatal pneumonia,fungal infection,bronchial hypoplasia(BPD),neonatal sepsis,intracranial hemorrhage.Univariate analysis was carried out through two groups of non parenteral nutrition relative factors(duration of antibiotic use,a fast time mechanical ventilation,noninvasive ventilation)and parenteral nutrition relative factors(maximum daily use of amino acids,total amount of amino acids,maximum daily use of fat emulsion,total use of fat emulsion,Average heat card and heat nitrogen ratio in the first 14 days,PN duration.),and then multivariate logistic regression was used to analyze the independent risk factors.2.Parenteral nutrition(PN): all premature infants who cannot take orally,cannot tolerate enteral feeding and have insufficient heat card need to use PN.Including20% medium and long chain fat emulsion,6% children’s compound amino acid injection,5%-50% glucose injection,electrolyte,trace elements,etc.The initial liquid volume is 80ml/kg,increasing day by day to 150-180ml/kg.Gradually transition to complete enteral feeding according to the feeding situation of children.Results:1.Retrospective analysis of 344 cases of premature infants,48 cases had PNAC,296 cases did not have PNAC,the incidence rate was 13.95%(48/344).The analysis showed that there was no statistical significance between the two groups in gender(P > 0.05).The average gestational age of PNAC group(30.30 ± 2.15)w was lower than that of non PNAC group(31.91 ± 1.81)w(t =-5.551 p < 0.001),and the average weight of PNAC group(1277.29 ± 298.50)g was lower than that of non PNAC group(1539.97 ± 249.94)g(t =-6.565 P < 0.001).2.Compare the relevant clinical disease factors of two groups:the analysis showed that there was no statistical significance between the two groups in NRDS,HIE,neonatal asphyxia,neonatal anemia,apnea,patent ductus arteriosus,respiratory failure,neonatal pneumonia,fungal infection,BPD(P > 0.05).Sepsis occurred in 10cases(20.83%)in PNAC group,which was higher than that in 8 cases(2.70%)in non PNAC group(χ~2 = 27.382 P < 0.001).Intracranial hemorrhage occurred in 4cases(8.33%)in PNAC group,which was higher than that in non PNAC group,and intracranial hemorrhage occurred in 5cases(1.69%)(χ~ 2 = 4.786 P =0.029).Therefore the analysis showed that there was statistical significance between Sepsis,intracranial hemorrhage(P < 0.05).3.Compare the relevant factors of Non PN between the two groups: the analysis showed that there was no statistical significance between the two groups mechanical ventilation and noninvasive ventilation(P > 0.05).The antibiotic time in PNAC group was 62(48～85.72)d longer than that in non PNAC group was 36(28.25～48.00)d(Z =-3.993 P < 0.001).A fast time in PNAC group was 2(2～4)d longish than that in non PNAC group was 1(1～2)d(Z =-7.608 P <0.001).Therefore the analysis showed that there was statistical significance between the antibiotic time,a fast time(P < 0.05).4.Compare the relevant factors of PN between the two groups: the average maximum daily use of amino acids in PNAC group(2.38 ± 0.41)g/kg/d is higher than that in non PNAC group(1.97 ± 0.46)g/kg/d(t = 6.202 P < 0.001).The total amount of amino acids in PNAC group was 80.06(57.76～119.73)g/kg,which was higher than 38.53(29.10～53.63)g/ kg in non PNAC group(Z =-7.473 P < 0.001).The average maximum amount of fat emulsion used in PNAC group(2.49 ±0.59)g/kg/d was higher than that in non PNAC group(2.28 ± 0.54)g/kg/d(t = 2.452 P = 0.015).The PN duration Average heat card in the first 14 days(100.69 ± 25.94)kcal/kg/d in PNAC group was higher than that in non PNAC group(88.38 ± 22.35)kcal/kg/d(t =-3.457 P = 0.001).The PN duration 49(38.25～61.25)in PNAC group was longer than that 29(23～38)in non PNAC group(Z =-7.102 P < 0.001).Therefore,there were significant differences between the two groups in amino acid consumption,maximum daily use of fat emulsion,heat card and PN duration on the14 th day(P < 0.05).There was no significant difference in Average heat nitrogen ratio in the 14 th days and total dose of fat emulsion between the two groups(P >0.05).5.Using binary logistic regression analysis,we found that neonatal sepsis(OR =6.72 P =0.002 95%CI = 2.027~22.277)、the maximum daily use of amino acids(OR= 4.54 P = 0.001 95%CI = 1.843~11.182)、Average heat card in the first 14 days(OR= 1.044 P < 0.001 95%CI = 1.023~1.066)were the independent risk factors of PNAC.Conclusions:Neonatal sepsis、maximum daily use of amino acids 、Average heat card in the first 14 days are independent risk factors for PNAC.