Background Parenteral nutrition associated cholestasis (PNAC) is one of the most alarming disease of prematurity and SGA infants seem to be more prone to this complication.
Objective To assess the role of intrauterine growth retardation on PNAC development.
Methods Records of VLBW infants admitted to our NICU during the last 10 years and exposed to parenteral nutrition >14 days were reviewed. PNAC was defined by direct bilirubin >2.0 mg/dl. Clinical data and nutritional intakes were compared between infants who developed CNAP and controls.
Results Among 446 selected infants, 55 (12.3%) developed PNAC; these infants had lower BW (850±274 vs 1052±238 g) and lower GA (27.4±2.5 vs 28.7±2.3 wks). The prevalence of SGA infants (30.9 vs 28.6% BW<10th percentile; 12.7 vs 10% BW<3rd percentile) and BW z-score (−0.82±1.17 vs −0.60±1.11) were similar in the two groups. During the first 28 days of life PNAC infants received lower amount of enteral fluids (25.8±20.7 vs 67.9±33.0 ml/Kg) and higher intakes (g/kg/d) of intravenous glucose (10.6±1.3 vs 7.5±2.5), lipids (1.8±0.4 vs 1.3±0.5) and protein (2.7±0.5 vs 1.9±0.7). PNAC group required more days of mechanical ventilation (12.1±11.4 vs 5.1±4.4) and oxygen (18.4±9.6 vs 9.6±6.3). Multiple logistic regression analysis identified enteral fluid intakes at 21 days of life (OR 0.64; 95% CI 0.51 to 0.79) and oxygen days (OR 1.05; 95% CI 1.01 to 1.10) as the best independent pedictors for PNAC.
Conclusions Intrauterine growth retardation does not represent a significative risk factor for PNAC whereas our data support the preventive role of early enteral feeding.