The association of cyclic parenteral nutrition and decreased incidence of cholestatic liver disease in patients with gastroschisis

Aaron R. Jensen, Adam B. Goldin, Joseph S. Koopmeiners, Jennifer Stevens, John H.T. Waldhausen, Stephen S. Kim

Research output: Contribution to journalArticlepeer-review

53 Scopus citations

Abstract

Purpose: The aim of the study was to investigate the effect of prophylactic cycling of parenteral nutrition (PN) on PN-induced cholestasis in patients with gastroschisis. Methods: Retrospective review of initial hospital admission charts for each patient with gastroschisis from 1996 to 2007 was performed. Results: One hundred seven patients were analyzed (36 prophylactically cycled, 71 control). Prophylactic cycling of PN was initiated at a mean age of 23 days (range, 7-89 days). Patients were followed for a total of 4255 days with 27 developing hyperbilirubinemia (cycled, 5; continuous, 22). Time to hyperbilirubinemia was longer in the prophylactically cycled group (P = .005). Cumulative incidence of hyperbilirubinemia at 25 and 50 days of PN exposure was 5.7% and 9.8% (cycled) vs 22.3% and 48.8% (continuous). At any given time, children in the continuous group were 4.76 times more likely to develop hyperbilirubinemia (95% confidence interval, 1.62-14.00). After adjusting for confounding factors, children in the continuous group were 2.86 times more likely to develop hyperbilirubinemia (95% confidence interval, 0.86-9.53), but the difference was not significant (P = .088). Conclusions: Prophylactic cyclic PN is associated with a decreased incidence and prolonged time to onset of hyperbilirubinemia. Other factors, however, significantly affect this relationship. Prospective randomized investigation is warranted to investigate for a possible causal relationship.

Original languageEnglish (US)
Pages (from-to)183-189
Number of pages7
JournalJournal of Pediatric Surgery
Volume44
Issue number1
DOIs
StatePublished - Jan 1 2009
Externally publishedYes

Keywords

  • Cholestasis
  • Cycled
  • Cyclic
  • Gastroschisis
  • Hyperalimentation
  • Hyperbilirubinemia
  • Neonatal
  • Nutrition
  • Parenteral
  • TPN

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