Abstract
Introduction
Parenteral nutrition associated cholestasis (PNAC) is a common morbidity in neonates
requiring total parenteral nutrition (TPN). Previous studies in infants with intestinal
failure have shown a benefit of mixed lipid emulsion (MLE) in reducing PNAC. It is
not known whether this benefit extends to a general neonatal intensive care unit (NICU)
population, where MLE is used on a selective basis. The objective of this study is
to examine associations between MLE use and PNAC rate in the general NICU setting.
Methods
This is a retrospective review of NICU patients who received TPN for 7 or more days.
We compared patients born between 1/1/2014 and 12/31/2015 (pre-MLE) to patients born
between 7/1/2017 and 12/31/2018 (post-MLE). Fisher's exact test and two-sample t-test were used to compare the two groups.
Results
There were 353 patients in 2014-2015 and 271 patients in 2017-2018. Demographics were
similar between the two groups, but there were more patients with congenital heart
disease in the MLE era (P < 0.001). Mortality was similar (6.2% pre-MLE versus 6.3% post-MLE). There was no significant difference in PNAC rate between the pre-MLE
(11.5%) and post-MLE (14.1%) patient cohorts (P = 0.342). Among patients receiving MLE (n = 38), 58% developed PNAC, while only 6.4% of the post-MLE cohort not receiving MLE
developed PNAC. Of the patients coded with a surgical diagnosis, there was no significant
difference in PNAC rates between pre-MLE and post-MLE groups. Discharge rates of PNAC
did differ between pre-MLE surgical patients (13.0%) and post-MLE surgical patients
(8.2%). In the subgroup of post-MLE surgical patients, PNAC rate differed significantly
between those receiving MLE (43.5%) and not receiving MLE (15.4%). However, this difference
was resolved by discharge (8.7% versus 7.7%).
Conclusions
There were no significant differences in PNAC rates between the pre-MLE and post-MLE
cohorts. However, in surgical patients, MLE was associated with reduced PNAC at discharge,
with levels equivalent to those seen in neonates receiving TPN for 7 or more days,
despite having a higher starting rate of PNAC. Further studies are needed to determine
whether the general NICU population may benefit from MLE or certain selective subpopulations
like surgical patients.
Keywords
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Article info
Publication history
Published online: February 22, 2023
Accepted:
January 21,
2023
Received in revised form:
December 26,
2022
Received:
March 1,
2022
Identification
Copyright
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