Risk factor analysis of parenteral nutrition‐associated cholestasis in extremely low birth weight infants

Lee, Hyon Hui; Jung, Ji Mi; Nam, So‐Hyun; Lim, Gina; Chung, Myung‐Sub

doi:10.1111/apa.13441

Cited by 16 publications

(17 citation statements)

References 31 publications

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“…This may be due to the sample size consistent with a previous similar‐sized study wherein multiple regression modeling demonstrated that duration of PN was the only significant predictor of PNAC . Our study confirms associations between both sepsis and prolonged PN and PNAC . Mortality rates for SIP and NEC were as expected, and the lack of increased mortality with PNAC is consistent with published data.…”

Section: Discussionsupporting

confidence: 91%

See 1 more Smart Citation

Predictive Value of the Aspartate Aminotransferase to Platelet Ratio Index for Parenteral Nutrition–Associated Cholestasis in Premature Infants With Intestinal Perforation

Vongbhavit

Underwood

2017

J Parenter Enteral Nutr

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Section: Discussionsupporting

confidence: 91%

“…Mortality rates for SIP and NEC were as expected, and the lack of increased mortality with PNAC is consistent with published data. Several studies have noted an increased risk of PNAC in premature infants with NEC with perforation …”

Section: Discussionmentioning

confidence: 99%

Predictive Value of the Aspartate Aminotransferase to Platelet Ratio Index for Parenteral Nutrition–Associated Cholestasis in Premature Infants With Intestinal Perforation

Vongbhavit

Underwood

2017

J Parenter Enteral Nutr

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“…First, the PN duration (23 days, range: 18-32 days) of the PNAC group was shorter than previous studies. 1,[14][15][16][17] Second, infants in our study received lower doses of lipids (1.5 g/kg/day, range: 1.2-1.8 g/kg/day), 1,[16][17][18] as well as glucose (8.8 g/kg/day, range: 7.1-10.7 g/kg/day) ,1,19,20 which have been reported to be independent risk factors for PNAC. 1,7,14,18 Finally, we excluded infants who underwent surgery, who have a higher risk of developing PNAC.…”

Section: Incidence Of Pnacmentioning

confidence: 66%

“…1,7,14,18 Finally, we excluded infants who underwent surgery, who have a higher risk of developing PNAC. 4,7,20 Risk factor of PNAC Prematurity and low birthweight (LBW) are defined as risk factors of PNAC in some studies, 15,20,21 which are physiologically likely a result of the immature hepatic excretion of premature infants. 22 It is difficult to separate prematurity, birthweight and duration of PN because prematurity and LBW generally need a longer administration of PN.…”

Section: Incidence Of Pnacmentioning

confidence: 99%

Risk factors of parenteral nutrition‐associated cholestasis in very‐low‐birthweight infants

Wang

Yan

Hong

et al. 2020

J Paediatrics Child Health

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Aim: We aimed to explore risk factors associated with parenteral nutrition-associated cholestasis (PNAC) in very-low-birthweight (VLBW) infants. Methods: VLBW infants receiving parenteral nutrition (PN) for at least 14 days were enrolled in a retrospective dual-centre study and divided into two groups chronologically: group A (2000-2007) and group B (2008-2015). The incidence of PNAC and related factors were investigated. We compared the differences between PNAC and non-PNAC groups. A multivariate binary logistic regression analysis was carried out to identify the potential risk factors of PNAC. Results: A total of 387 VLBW infants (53 in group A and 334 in group B) were enrolled in the study. The total incidence of PNAC was 6.7%, 9.4% in group A and 6.3% in group B. The dosage of amino acid (P = 0.009), glucose (P = 0.006), PN calories (P = 0.021) and the ratio of glucose/fat (P = 0.014) were significantly higher in group B than in group A. Non-protein energy to nitrogen ratio (P = 0.017) was lower in group B. Birthweight was significantly lower in the PNAC group than in the non-PNAC group (P = 0.021). Subgroup analysis showed that gestational age and duration of PN were significantly different between the PNAC and non-PNAC groups (P < 0.05). Logistic regression showed that prolonged duration of PN (≥43 days) (odds ratio 3.155, 95% confidence interval 1.009-9.861, P = 0.048) was an independent risk factor of PNAC. Conclusions: For VLBW infants, prolonged duration of PN is a risk factor for the development of PNAC. PNAC may be prevented by weaning off PN as early as possible in VLBW infants.

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“…With regard to monitoring, we again found significant differences across recommendations depending on specimen type (capillary or venous), previous lead result, and lead result trends over time. Most guidance sources Arkansas [40], North Dakota [41], Wyoming [42] Lead Level ≥ 3 μg/dL (1) New Hampshire [43,44] Lead Level ≥ 5 μg/dL b (37) Alabama [45], Alaska [46], Arizona [47,48], California [49,50], Colorado [51,52], Connecticut [53,54], District of Columbia [55,56], Georgia [57][58][59], Hawaii [60,61], Idaho [62,63], Illinois [64,65], Iowa [66,67], Kentucky [68,69], Louisiana [70][71][72], Maine [73,74], Maryland [75], Massachusetts [76][77][78][79], Michigan [80,81], Minnesota [82,83], Mississippi [84,85], Montana…”

Section: Follow-up Testingmentioning

confidence: 99%

More Guidelines than states: variations in U.S. lead screening and management guidance and impacts on shareable CDS development

2020

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Background: Pediatric lead exposure in the United States (U.S.) remains a preventable public health crisis. Shareable electronic clinical decision support (CDS) could improve lead screening and management. However, discrepancies between federal, state and local recommendations could present significant challenges for implementation. Methods: We identified publically available guidance on lead screening and management. We extracted definitions for elevated lead and recommendations for screening, follow-up, reporting, and management. We compared thresholds and level of obligation for management actions. Finally, we assessed the feasibility of development of shareable CDS. Results: We identified 54 guidance sources. States offered different definitions of elevated lead, and recommendations for screening, reporting, follow-up and management. Only 37 of 48 states providing guidance used the Center for Disease Control (CDC) definition for elevated lead. There were 17 distinct management actions. Guidance sources indicated an average of 5.5 management actions, but offered different criteria and levels of obligation for these actions. Despite differences, the recommendations were well-structured, actionable, and encodable, indicating shareable CDS is feasible. Conclusion: Current variability across guidance poses challenges for clinicians. Developing shareable CDS is feasible and could improve pediatric lead screening and management. Shareable CDS would need to account for local variability in guidance.

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Risk factor analysis of parenteral nutrition‐associated cholestasis in extremely low birth weight infants

Abstract: PNAC was common in ELBW infants, was associated with various clinical factors and increased the risk of mortality. However, we did not observe the protective effect of FOLP against PNAC.

Cited by 16 publications

References 31 publications

Predictive Value of the Aspartate Aminotransferase to Platelet Ratio Index for Parenteral Nutrition–Associated Cholestasis in Premature Infants With Intestinal Perforation

Predictive Value of the Aspartate Aminotransferase to Platelet Ratio Index for Parenteral Nutrition–Associated Cholestasis in Premature Infants With Intestinal Perforation

Risk factors of parenteral nutrition‐associated cholestasis in very‐low‐birthweight infants

More Guidelines than states: variations in U.S. lead screening and management guidance and impacts on shareable CDS development

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