ผลกระทบจากสัดส่วนของ Non-Protein Calories : Nitrogen และปัจจัยเสี่ยงที่เกี่ยวข้องทั้งหมดต่อการเกิดภาวะน้ำดีคั่งจากการได้รับสารอาหารทางหลอดเลือดในทารกทีมีน้ำหนักแรกเกิดน้อยกว่า 1,500 กรัม

Authors

  • พงศธร ชิงชัย กลุ่มงานเภสัชกรรม โรงพยาบาลนครพิงค์ จังหวัดเชียงใหม่

Keywords:

PN, PNAC, NPcal:N ratio

Abstract

Effects of Non-Protein Calories : Nitrogen Ratio (NPcal:N) and All Risk Factors on Parenteral
Nutrition- Associated Cholestasis in Neonates.
Pongsatorn Chingchai, M. Pharm. (Clinical Pharmacy)
Pharmacy department, Nakornping hospital, Chiangmai
Introduction: The etiology of parenteral nutrition-associated cholestasis (PNAC) in neonates is multifactorial, especially
non-protein calories : nitrogen (NPcal:N) ratio which previous studies are very few.
Objective: To study the association of NPcal:N ratio and all risk factors to develop PNAC in neonates.
Methods: Retrospective cohort study in infants weighing less than 1,500 g and recieving parenteral nutrition (PN)
for at least 14 days between 2009 and 2016. Patients were divided into two groups, infants with and without PNAC.
Analyzed significant factors by logistic regression and receiver operating characteristic curve (ROC Curve).
Results: Nine-hundreds and seventy-five infants who received PN were enrolled. 238 infants were eligible for this
study. Seventy-eight infants (8%) developed PNAC. After backward multivariable logistic regression analysis, we found that
PN with NPCal:N ratio more than 125:1 OR=1.953; CI 1.018-3.745, prolonged PN duration ≥ 14 days (OR =1.080; CI 1.041-
1.120) and delayed enteral nutrition (EN) start dated > 5 days after birth (OR=1.097; CI 1.008-1.194) were statistically
significant associated with the development of PNAC and the ROC curve analysis was 70.6 %.
Discussions: Guideline to decrease the development of PNAC as follows : keep NPCal:N ratio ≤ 125:1 with PN
duration infusion < 14 days and early EN start dated within 5 days after birth.
Key words: PN, PNAC, NPcal:N ratio

References

Nghiem-Rao TH, Dahlgren AF, Kalluri D, Cao Y, Simpson PM, Patel SB. Influence of gestational age and birth weight in neonatal cholesterol response to total parenteral nutrition. J Clin Lipidol 2016;10:891-7.

Boullata JI, Holcombe B, Sacks G, Gervasio J, Adams SC, Christensen M, et al. Parenteral nutrition safety committee, American society for parenteral and enteral

nutrition. standardized competencies for parenteral nutrition order review and parenteral nutrition preparation,including compounding: The ASPEN model. Nutr Clin Pract 2016;31:548-5.

Rangel SJ, Calkins CM, Cowles RA, Barnhart DC, Huang EY, Abdullah F, et al. Parenteral nutritionassociated cholestasis: an American pediatric surgical association outcomes and clinical trials committee systematic review. J Pediatr Surg 2012;47:225-40.

Lauriti G, Zani A, Aufieri R, Cananzi M, Chiesa PL, Eaton S, et al. Incidence, prevention, and treatment of parenteral nutrition-associated cholestasis and in testinal failure-associated liver disease in infants and children: a systematic review. JPEN J Parenter Enteral Nutr 2014;38:70-85.

Dilsiz A. Total parenteral nutrition-associated cholestasis in surgical neonates. Tr. J. of Medical Sciences 1999;29:689-92.

Hsieh MH, Pai W, Tseng Hi. Parenteral nutrition-associated cholestasis in premature babies: risk factors and predictors. Pediatr Neonatol 2009;50:202-7.

Dilsiz A. Total Parenteral Nutrition-Associated Cholestasis in Surgical Neonates. Tr. J. of Medical Sciences 1999;29:689-92.

Steinbach M, Clark RH, Kelleher AS, Flores C, White R, Chace DH, et al. Demographic and nutritional factors associated with prolonged cholestatic jaundice

in the premature infant. J Perinatol 2008;28(2):129-35.

Robinson DT, Ehrenkranz RA. Parenteral nutritionassociated cholestasis in small for gestational age infants. J Pediatr 2008;152(1):59-62.

Tufano M, Nicastro E, Giliberti P, Vegnente A, Raimondi F, Iorio R. Cholestasis in neonatal intensive care unit: incidence, aetiology and management. Acta Paediatr 2009;98:1756-61.

Kim AY, Lim RK, Han YM, Park KH, Byun SY. Parenteral Nutrition-Associated Cholestasis in Very Low Birth Weight Infants: A Single Center Experience. Pediatr Gastroenterol Hepatol Nutr 2016;19:61-70.

Jolin-Dahel K, Ferretti E, Montiveros C. Parenteral nutrition-induced cholestasis in neonates: Where does the problem lie?. Gastroenterol Res Pract 2013;2013:16.

Alkharfy TM, Ba-Abbad R, Hadi A, Sobaih BH, AlFaleh KM. Total parenteral nutrition-associated cholestasis and risk factors in preterm infants. Saudi J Gastroenterol 2014;20:293-14.Ray CA.

Parenteral nutrition. In: Boh LE, editor.Clinical clerkship manual. Washington: Applied Therapeutics; 1993. p. 1-28.

Blau J, Sridhar S, Mathieson S, Chawla A. Effects of protein/nonprotein caloric intake on parenteral nutrition associated cholestasis in premature infants weighing 600-1000 grams. JPEN J Parenter Enteral Nutr 2007;31:487-90.

Shin JI, Namgung R, Park MS, Lee C. Could lipid infusion be a risk for parenteral nutrition-associated cholestasis in low birth weight neonates? Eur J Pediatr 2008;167:197-202.

Rollins MD, Ward RM, Jackson WD, Mulroy CW, Spencer CP, Ying J, et al. Effect of decreased parenteral soybean lipid emulsion on hepatic function in infants

at risk for parenteral nutrition-associated liver disease: a pilot study. J Pediatr Surg 2013;48:1348-56.

Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol 2007;165:710-8.

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Published

2020-08-11

How to Cite

ชิงชัย พ. (2020). ผลกระทบจากสัดส่วนของ Non-Protein Calories : Nitrogen และปัจจัยเสี่ยงที่เกี่ยวข้องทั้งหมดต่อการเกิดภาวะน้ำดีคั่งจากการได้รับสารอาหารทางหลอดเลือดในทารกทีมีน้ำหนักแรกเกิดน้อยกว่า 1,500 กรัม. Thai JPEN วารสารโภชนบำบัด, 26(1), 35–44. retrieved from https://he02.tci-thaijo.org/index.php/ThaiJPEN/article/view/244240

Issue

Vol. 26 No. 1 (2018): January-April 2018

Section

Research article

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