Incidence of Parenteral Nutrition-Associated Liver Disease in Infants on Prolonged Parenteral Nutrition with a Soybean-Based Lipid Emulsion: A 7-Year Experience

Parenteral nutrition associated liver disease (PNALD) is a significant\r\ncomplication in infants receiving long-term parenteral nutrition (PN). Chronic\r\nadministration of PN has been associated with its development. Our purpose is\r\nto characterize our incidence of PNALD over an extended period and identify\r\nrisk factors for its development, including administration of soybean-based\r\ninjectable lipid emulsions (ILEs) as we transit to novel ILEs in our practice.\r\nInfants receiving 30 days or more of PN were included. PNALD was defined as a\r\ndirect bilirubin ≥ 2 mg/dL. Data collected included: patient demographics,\r\nclinical and enteral feeding characteristics. Macronutrient intake was recorded\r\nusing these cut-offs: glucose infusion rate (GIR) of ≤14 mg/kg/min or above,\r\nprotein doses of ≤3 g/kg/day or above and lipid doses of ≤2 g/kg/day or above. A total of 349 infants\r\nwere included, with an annual incidence of PNALD ranging between 34% - 54%. Infants with PNALD were younger by gestation\r\n(27 vs. 29.5 weeks) and smaller by birthweight (900 vs. 1248 grams). Sepsis, GI\r\ndisease including necrotizing enterocolitis and bowel resection were\r\nsignificantly associated with an increased risk for development of PNALD. PNALD\r\ninfants received lower protein doses (3.0 vs 3.3 g/kg/day, p = 0.014) while\r\nreceiving higher GIR (11.4 vs 10.7 mg/kg/min, p = 0.012) compared to non-PNALD\r\ninfants. Low birth weight, sepsis and bowel resection remain strong indicators\r\nof risk for PNALD. No single macronutrient increased our infants’ risk for\r\nPNALD. The use of newer ILEs when available should be evaluated for their\r\nimpact on PNALD development.