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Total Parenteral Nutrition-associated Cholestasis in Premature Infants

Journal of the Korean Pediatric Society 2003;46(1):17-23.
Published online January 15, 2003.
Total Parenteral Nutrition-associated Cholestasis in Premature Infants
Kyung Pil Park, Se Young Kim, Heng Mi Kim
Department of Pediatrics, College of Medicine, Kyungpook University, Daegu, Korea
미숙아에서의 전비경구적 영양 관련 담즙울체
박경필, 김세영, 김행미
경북대학교 의과대학 소아과학교실
Correspondence: 
Heng Mi Kim, Email: hmkim@knu.ac.kr
Abstract
Purpose
: Cholestasis is a major complication in prolonged use of TPN, especially in the neonatal period, but there are few long-term reviews examining the clinical course in premature infants. Thus, in this study, we reviewed premature infants with TPN-associated cholestasis(TPNAC) to determine the incidence, clinical courses and possible risk factors.
Methods
: Retrospective review of 66 premature infants less than 2,000 gm of birth weight and on TPN for more than two weeks was performed. Cholestasis was defined as a serum direct bilirubin level greater than 2.0 mg/dL. The clinical course of cholestasis was described, and perinatal risk factors were evaluated.
Results
: TPNAC developed in 21 out of 66 infants(31.8%). The onset was 41.7?7.4 days after receiving TPN, and the mean duration was 33.6?3.4 days. The incidence of TPNAC was significantly correlated with birth weight, and gestational age, and duration of TPN. But, possible etiologic factors, such as incidence of perinatal asphyxia or infection, showed no remarkable differences between infants with TPNAC and those without TPNAC(control). The enteral intake in the third postnatal week was significantly smaller in infants with TPNAC than in the control infants(P=0.033).
Conclusion
: The enteral intake in the third postnatal week was smaller in the infants with TPNAC than in the control infants. Thus, the incidence of TPNAC may be reduced by increasing the amount of oral intake during TPN in high risk infants.
Key Words: Total parenteral nutrition, TPN-associated cholestasis, Premature infants


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