PhilSPEN Online Journal of Parenteral and Enteral Nutrition

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(Article 74 | POJ_0068)

Submitted Abstracts

PENSA 2017 Congress

Submitted: August 3, 2017

Abstract ID = 38 | Classification: (6) - Parenteral nutrition

Title: Effects of non-protein calories : nitrogen ratio and all possible risk factors on parenteral nutrition– associated cholestasis in low birth weight neonates.

Author(s): Chingchai, Pongsatorn

Institution where study was conducted: Pharmacy department, Nakornping hospital, Chiangmai, Thailand.

Keywords: Parenteral nutrition, parenteral nutrition-associated cholestasis, non-protein calories : nitrogen ratio

Background: Parenteral nutrition-associated cholestasis (PNAC) has historically been a significant cause of morbidity and mortality in neonates. Previous studies have shown that the etiology of PNAC is multifactorial. Non-protein calories to Nitrogen (NPCal:N) ratio has been implicated as possible cause of PNAC in some previous studies but not significantly.

Objectives: To evaluate all possible risk factors and identify the optimal NPcal:N ratio to prevent PNAC.

Methods: Retrospective cohort study of neonates who were admitted to our neonatal intensive care unit at Nakornping hospital that all neonates weighed < 2,500 g and recieved parenteral nutrition (PN) infusion ≥ 14 days between 2009 and 2016. Patients were divided in two groups with and without PNAC. Cholestasis was defined as a serum total bilirubin (TB) ≥ 2.0 mg/dL, with a serum direct bilirubin (DB) ≥ 20% of the TB. Data were collected from medical records for 26 risk factors. Analyzed differences of risk factors between groups by univariate analysis then selected significant risk factors (p<0.05) were analyzed by logistic regression and receiver operating characteristic (ROC) curve.

Results: 975 neonates who received PN were enrolled. 278 neonates were eligible for this study; 92(9.44 %) of the neonates developed PNAC. NPcal:N ratio >125:1(OR =1.923;CI 1.073-3.446), prolonged PN duration(OR =1.077;CI 1.041-1.115) and delayed enteral nutrition(EN) feeding(OR=1.100;CI 1.023-1.183) were most significant after backward multivariable logistic regression analysis. ROC curve analysis of these factors was 71.4 %.

Conclusion: NPcal:N ratio >125:1(new clinical finding), PN duration ≥ 14 days and delayed EN feeding ≥ 5 days after birth were significant risk factors to develop PNAC in this study.