Preterm Small for Gestational Age Infants Are Not at Higher Risk for Parenteral Nutrition–Associated Cholestasis

Objective

To assess if being small for gestational age impacts parenteral nutrition–associated cholestasis (PNAC) development.

Study design

We reviewed all the very low–birth weight infants exposed to parenteral nutrition for >14 days from 1996 to 2006, comparing auxological and clinical data, as well as nutritional history, during the first 4 weeks of life of infants with cholestasis and control subjects.

Results

Of 445 very low–birth weight infants, 55 had development of PNAC. Infants with cholestasis had lower birth weight and gestational age but similar birth weight z-score compared with infants without cholestasis, and they received a lower amount of enteral feeds (25.8 ± 20.7 vs 67.9 ± 33.0mL/kg, P < .001), a greater amount of intravenous glucose (10.6 ± 1.3 vs 7.5 ± 2.5g/kg, P < .0001), lipids (1.8 ± 0.4 vs 1.3 ± 0.5, P < .0001) and proteins (2.7 ± 0.5 vs 1.9 ± 0.7, P < .0001), and needed a higher number of days of fasting (13.2 ± 6.7 vs 6.5 ± 4.8, P < .001). Enteral intake between 0 and 21 days of life (OR 0.66; 95% CI 0.53, 0.81, P < .0001) and oxygen therapy (OR 1.05; 95% CI 1.01, 1.09; P = .030) were identified as the best independent predictors of PNAC.

Conclusions

Enteral feeding remains the main factor for the prevention of PNAC, whereas small for gestational age infants do not have a higher risk of PNAC.

AGA, Appropriate for gestational age, BPD, Bronchopulmonary dysplasia, BW, Birth weight, GA, Gestational age, IUGR, Intrauterine growth restriction, NEC, Necrotizing enterocolitis, NICU, Neonatal intensive care unit, PN, Parenteral nutrition, PNAC, Parenteral nutrition associated cholestasis, SGA, Small for gestational age, VLBW, Very low birth weight