Parenteral Nutrition-Associated Cholestasis in Small for Gestational Age Infants

Objective

To identify small for gestational age (SGA) as an independent risk factor for parenteral nutrition-associated cholestasis (PNAC).

Study design

In a case-control study, records of infants treated in the neonatal intensive care unit from 1994 through 2003 with gestational ages (GA) <34 weeks and exposure to parenteral nutrition (PN) ≥7 days were reviewed. The primary outcome was the incidence of cholestasis in infants who were SGA. Secondary outcomes included PN duration, age at full enteral nutrition (FEN) and incidence of late-onset sepsis, necrotizing enterocolitis (NEC) and bronchopulmonary dysplasia (BPD). Analysis was by t test, logistic regression, and χ² analysis.

Results

Cases (n = 79) and control subjects (n = 152) had similar birth weights and GA (963 ± 465 g versus 1090 ± 463 g; 27 ± 2 weeks versus 27 ± 2 weeks; [mean ± SD]). Of the infants who were SGA, 58% developed cholestasis (OR = 3.3, P < .01). Infants with cholestasis achieved FEN later (43 ± 25 days versus 23 ± 11 days) and had higher rates of sepsis (80% versus 34%), NEC (51% versus 7%), and BPD (65% versus 25%; P < .01). Of infants with cholestasis, infants who were SGA received fewer days of PN than infants who were appropriate for GA (49 ± 24 days versus 68 ± 36 days, P = .024).

Conclusion

Being SGA is an independent risk factor for PNAC. Infants who are SGA require less PN for cholestasis to develop.

Abbreviations: AGA, Appropriate for gestational age, BPD, Bronchopulmonary dysplasia, FEN, Full enteral nutrition, GA, Gestational age, NEC, Necrotizing enterocolitis, NICU, Neonatal intensive care unit, PN, Parenteral nutrition, PNAC, Parenteral nutrition-associated cholestatsis, SGA, Small for gestional age