Identifying patients, on the first day of life, at high-risk of developing parenteral nutrition-associated liver disease
Identifying patients, on the first day of life, at high-risk of developing parenteral nutrition-associated liver disease
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DOI：
10.1038/sj.jp.7211686
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发表时间：
2007-05-01
影响因子：
2.9
通讯作者：
Lambert, D. K.
中科院分区：
文献类型：
--
作者：
Christensen, R. D.;Henry, E.;Lambert, D. K.
背景：新生儿长期使用肠外营养（PN）可导致肠外营养相关性肝病（PNALD），表现为直接胆红素浓度升高，在某些情况下进展为肝衰竭。当在新生儿重症监护病房（NICU）中预防PNALD的新潜在手段（如使用Omegaven）在临床试验中进行测试时，这些研究应纳入发生PNALD风险非常高的新生儿。然而，并不总是清楚，在生命的最初几天，哪些新生儿最有可能发展为PNALD。因此，为了设计预防PNALD的研究，我们对所有接受PN治疗bb0 = 14天的NICU患者进行了评估，评估他们发生PNALD的可能性。方法：我们对所有出生日期在2002年1月1日至2006年6月30日期间在Intermountain医疗保健系统接受PN治疗14天或更长时间的新生儿进行了历史性队列分析。结果：在41/2年的时间里，9861名新生儿在Intermountain Healthcare nicu得到照顾。其中9547例（96.8%）存活28 d以上，6543例（68.5%）接受PN治疗。21%（1366例）的患者接受了14天的PN治疗。通过胆红素>= 2.0 mg/dl直接测定PNALD。术后14 ~ 28天新生儿PNALD发生率为14%，29 ~ 56天发生率为43%，57 ~ 100天发生率为72%，bb0 ~ 100天发生率为85%。在出生第一天就被确定为患PNALD风险最高的患者群体是出生体重
Background: Prolonged use of parenteral nutrition (PN) in neonates can lead to parenteral nutrition-associated liver disease (PNALD), manifested by elevated direct bilirubin concentrations, and in some cases progressing to hepatic failure. When new potential means of preventing PNALD in the neonatal intensive care unit (NICU), such as Omegaven usage, are tested in clinical trials, the studies should enroll neonates at a very high risk of developing PNALD. However, it is not always clear, in the first days of life, which neonates are most likely to develop PNALD. Therefore, preparatory to devising studies of prophylaxis against PNALD, we conducted an evaluation of all NICU patients who received PN for >= 14 day, assessing their likelihood of developing PNALD.Methods: We performed an historic cohort analysis of all neonates in the Intermountain Healthcare system, receiving PN for 14 days or more during their stay, with dates of birth between 1 January, 2002 and 30 June, 2006.Results: During the 41/2-year period, 9861 neonates were cared for in the Intermountain Healthcare NICUs. Of these, 9547 (96.8%) survived for at least 28 days, and of these 6543 (68.5%) received PN. Twenty-one percent (1366 patients) of those receiving PN, received it for >= 14 days. PNALD was ascertained in this group by a direct bilirubin >= 2.0 mg/dl. Neonates receiving PN for 14-28 days had a 14% incidence of PNALD, those receiving PN for 29-56 days had a 43% incidence, those receiving PN for 57-100 days had a 72% incidence and those receiving PN for >100 days had a 85% incidence. Groups of patients identifiable on the first day of life as having the highest risk of developing PNALD were birth weight