TITLE:
Incidence of Parenteral Nutrition-Associated Liver Disease in Infants on Prolonged Parenteral Nutrition with a Soybean-Based Lipid Emulsion: A 7-Year Experience
AUTHORS:
Catherine M. Crill, Oscar R. Herrera, Lindsay H. Stuart, Michael L. Christensen
KEYWORDS:
Parenteral Nutrition, Infants, Lipid Emulsions, Liver Disease, Cholestasis
JOURNAL NAME:
Food and Nutrition Sciences,
Vol.11 No.10,
October
15,
2020
ABSTRACT: Parenteral nutrition associated liver disease (PNALD) is a significant
complication in infants receiving long-term parenteral nutrition (PN). Chronic
administration of PN has been associated with its development. Our purpose is
to characterize our incidence of PNALD over an extended period and identify
risk factors for its development, including administration of soybean-based
injectable lipid emulsions (ILEs) as we transit to novel ILEs in our practice.
Infants receiving 30 days or more of PN were included. PNALD was defined as a
direct bilirubin ≥ 2 mg/dL. Data collected included: patient demographics,
clinical and enteral feeding characteristics. Macronutrient intake was recorded
using these cut-offs: glucose infusion rate (GIR) of ≤14 mg/kg/min or above,
protein doses of ≤3 g/kg/day or above and lipid doses of ≤2 g/kg/day or above. A total of 349 infants
were included, with an annual incidence of PNALD ranging between 34% - 54%. Infants with PNALD were younger by gestation
(27 vs. 29.5 weeks) and smaller by birthweight (900 vs. 1248 grams). Sepsis, GI
disease including necrotizing enterocolitis and bowel resection were
significantly associated with an increased risk for development of PNALD. PNALD
infants received lower protein doses (3.0 vs 3.3 g/kg/day, p = 0.014) while
receiving higher GIR (11.4 vs 10.7 mg/kg/min, p = 0.012) compared to non-PNALD
infants. Low birth weight, sepsis and bowel resection remain strong indicators
of risk for PNALD. No single macronutrient increased our infants’ risk for
PNALD. The use of newer ILEs when available should be evaluated for their
impact on PNALD development.