Abstract：
OBJECTIVE: To investigate the clinical characteristics and course of parenteral nutrition-associated cholestasis (PNAC) in very low birth weight (VLBW) infants.
METHODS: The charts of VLBW infants were retrospectively reviewed. The clinical characteristics of infants with and without PNAC were compared, trends in liver enzymes were investigated, and the characteristics of infants with PNAC were analysed based on age of onset.
RESULTS: PNAC was observed in 53 (13.2%) of 403 infants who survived and completed follow-up and was associated with significantly lower gestational age, birth weight, and adverse neonatal outcomes. PNAC started at a median 32 (interquartile range 23-47) days, PN was applied for 53 (34.5-64.5) days, the maximum direct bilirubin (DB) was observed at 63 (50-76) postnatal days, and PNAC resolved at 94 (79-122) postnatal days postnatal age. PNAC lasted 61 (38-89.5) days. AST and ALT normalised at 111 (100.3-142.0) and 109.5 (97-161.3) postnatal days. Infants with early-onset PNAC had significantly longer PN duration, higher maximum DB, and higher maximum AST than those with late-onset PNAC.
CONCLUSIONS: Elevated DB, AST, and ALT persist for a long period after discontinuing PN. We suggest a cautious approach that involves waiting and reducing the frequency of additional repetitive examinations.
METHODS: The charts of VLBW infants were retrospectively reviewed. The clinical characteristics of infants with and without PNAC were compared, trends in liver enzymes were investigated, and the characteristics of infants with PNAC were analysed based on age of onset.
RESULTS: PNAC was observed in 53 (13.2%) of 403 infants who survived and completed follow-up and was associated with significantly lower gestational age, birth weight, and adverse neonatal outcomes. PNAC started at a median 32 (interquartile range 23-47) days, PN was applied for 53 (34.5-64.5) days, the maximum direct bilirubin (DB) was observed at 63 (50-76) postnatal days, and PNAC resolved at 94 (79-122) postnatal days postnatal age. PNAC lasted 61 (38-89.5) days. AST and ALT normalised at 111 (100.3-142.0) and 109.5 (97-161.3) postnatal days. Infants with early-onset PNAC had significantly longer PN duration, higher maximum DB, and higher maximum AST than those with late-onset PNAC.
CONCLUSIONS: Elevated DB, AST, and ALT persist for a long period after discontinuing PN. We suggest a cautious approach that involves waiting and reducing the frequency of additional repetitive examinations.
摘要：
目的：探讨极低出生体重儿肠外营养相关性胆汁淤积(PNAC)的临床特点和病程。
方法：回顾性分析VLBW婴儿的图表。比较有和没有PNAC的婴儿的临床特征，研究了肝酶的趋势，并根据发病年龄分析了PNAC婴儿的特征。
结果：在403名存活并完成随访的婴儿中，有53名（13.2％）观察到PNAC，并与显着降低的胎龄有关，出生体重,和不良的新生儿结局。PNAC开始于中位数32天(四分位数间距23-47天)，PN应用了53(34.5-64.5)天，最大直接胆红素（DB）在出生后63（50-76）天观察到，PNAC在出生后94天（79-122）解决。PNAC持续了61（38-89.5）天。AST和ALT在出生后111天(100.3-142.0天)和109.5天(97-161.3天)恢复正常。早发性PNAC的婴儿PN持续时间明显更长，更高的最大DB，最高AST高于晚发性PNAC。
结论：提升DB，AST,停止PN后，ALT持续很长一段时间。我们建议采取谨慎的方法，包括等待和减少额外的重复性检查的频率。
方法：回顾性分析VLBW婴儿的图表。比较有和没有PNAC的婴儿的临床特征，研究了肝酶的趋势，并根据发病年龄分析了PNAC婴儿的特征。
结果：在403名存活并完成随访的婴儿中，有53名（13.2％）观察到PNAC，并与显着降低的胎龄有关，出生体重,和不良的新生儿结局。PNAC开始于中位数32天(四分位数间距23-47天)，PN应用了53(34.5-64.5)天，最大直接胆红素（DB）在出生后63（50-76）天观察到，PNAC在出生后94天（79-122）解决。PNAC持续了61（38-89.5）天。AST和ALT在出生后111天(100.3-142.0天)和109.5天(97-161.3天)恢复正常。早发性PNAC的婴儿PN持续时间明显更长，更高的最大DB，最高AST高于晚发性PNAC。
结论：提升DB，AST,停止PN后，ALT持续很长一段时间。我们建议采取谨慎的方法，包括等待和减少额外的重复性检查的频率。
