Abstract 1659

Background. Cholestasis has been reported to occur in as many as 20-30% of neonates, especially those with low-birth weight, who receive long-term total parenteral nutrition (TPN). However, we could find no recent studies assessing the current incidence. We reviewed the UCSF experience to determine the incidence and to assess risk factors.

Methods. We performed a retrospective review of all children who have received TPN in our intensive care nursery (ICN) from 1/1/95 to 10/1/98. Cholestasis was defined as a conjugated bilirubin > 2.0 mg/dl. TPN cholestasis (TPNC) was defined as cholestasis with no other known cause for jaundice.

Results. 803 of the 1696 neonates (47%) admitted to our ICN during this period received TPN. The male:female ratio for those receiving TPN was 57%:43%. TPNC was found in 29 neonates (3.6%) and developed as early as 13 days after initiation of TPN (2 patients). Risk of TPNC by birth weight and prolonged duration (PD, >12 d) of TPN is included in the Table: Four factors were associated with increased risk of developing TPNC including: TPN duration > 60 days (p<0.002), necrotizing enterocolitis (NEC, p<0.001), bowel surgery (p<0.001), and surgical repair of congenital diaphragmatic hernia without extracorporeal membrane oxygenation (p<0.01). No other factors were associated with TPNC including cardiac surgery or sepsis. Fifteen patients recovered from their TPNC by the time of hospital discharge. Three of the 14 patients with persistent TPNC died, all from non-hepatic causes.

Table 1 No caption available

Conclusions. The rate of TPNC in neonates receiving long-term TPN was lower than often reported and did not differ in the 2 birth weight categories. Three intestinal-related complications were significantly associated with TPNC in our population. The relatively low rate of TPNC has prompted us to initiate a prospective, randomized controlled study to better evaluate factors associated with the development of TPNC.