| Objective:To investigate the risk factors for parental nutrition-associated cholestasis(PNAC)in preterm low birth weight infants and to provide a reference for clinicians to prevent and make treatment decisions of PNAC.Methods:Preterm low birth weight infants with applied parenteral nutrition(PN)≥14d were admitted to the Neonatal Intensive Care Unit(NICU)of the First Hospital of Jilin University,Changchun,China,between January 2019 and December 2021.In this study,infants who met the diagnosis of PNAC were the case group(PNAC group)and infants admitted to the NICU at the same time were randomly selected as the control group(non-PNAC group)according to the matching principle of 1:1.2.The children in the PNAC group were also divided into a transaminase-elevated group and a non-transaminase-elevated group according to the presence or absence of alanine transaminase(ALT)>50 U/L.General data,clinical comorbidities and indicators related to neonatal nutrition were compared between groups and a logistic multiple regression model was developed to analyse independent risk factors for PNAC development in preterm low birth weight infants.Result:1.In the study,115 neonatal were enrolled,52 in the PNAC group and 63 in the non-PNAC group.There were 59 males(51.3%)and 56 females(48.7%);birth weight 1.46(1.24,1.69)kg,gestational age(30.2±2.2)weeks and hospital stay 38.2(27.5,49.6)d.Clinical comorbidities included bronchopulmonary dysplasia(BPD)in 44 cases(38.4%),anemia in 83 cases(72.2%),sepsis in 38 cases(33%),and respiratory distress syndrome(RDS).The clinical comorbidities included bronchopulmonary dysplasia(BPD)in 44 cases(38.4%),anemia in 83 cases(72.2%),septicemia in 38 cases(33%),respiratory distress syndrome(RDS)in 74 cases(64.3%),necrotizing enterocolitis(NEC)in 20 cases(17.4%),and surgery in 14 cases(12.2%).NEC 14 cases(12.2%).2.The differences between the two groups were statistically significant(P<0.05)in terms of length of stay,birth weight,dose of lipids,amino acids,glucose intake dose,duration of fasting,duration of fat emulsion,duration of PN,septicemia,NEC,and surgical NEC;there were no significant differences in GA,sex,small gastric age(SGA),mode of delivery,BPD,and RDS(P>0.05);multifactorial logistic regression analysis showed PN duration(OR=2.204,95%CI:0.084-2.495,P<0.001),lipids dose(OR=1.143,95%Cl:0.055-3.721,P<0.001),combined sepsis(OR=1.977,95%CI.0.05-2.303,P=0.004),and surgical NEC(OR=1.626,95%CI:0.141-1.767,P=0.008)were all independent risk factors for the development of PNAC.3.transaminase-elevated occurred in 12 cases(10.7%)in the PNAC group.There was a statistically significant difference(P<0.05)in the duration of PN,duration of fasting,length of hospital stay,and surgical NEC between the infants in the transaminase-elevated group and the non-transaminase-elevated group.There was no statistically significant difference in general information,time to start milk,amino acid dose,fat emulsion dose,glucose dose and RDS between the two groups of infants(P>0.05).Multi-factor logistic regression analysis showed that PN duration(OR=2.041,95%CI:1.028-3.217,P=0.009)and surgical NEC(OR=1.135,95%CI:0.901-77.002,P=0.042)were independent risk factors for the development of transaminase-elevated in children with PNAC.Conclusion:1.PNAC is the result of a combination of factors,of which duration of PN,dose of intravenous fat emulsion intake,septicemia and surgical treatment of NEC are independent risk factors.2.Duration of PN and surgical treatment of NEC are independent risk factors for the development of transaminase-elevated in PNAC. |
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