| Popis: |
Introduction: Parenteral nutrition-associated cholestasis (PNAC) in surgical neonates remains the most challenging complication associated with administering parenteral nutrition (PN). This is because surgical neonates are already under significant immune and metabolic stress compared to older children. This study compares the risk of PNAC developed in surgical neonates receiving Soy-based Lipids (IL) to those receiving Mix-based lipids (SL). Method: Sophisticated criteria are set to ensure equality of conditions and eliminate the factors that may invariably affect the results. The incidence and severity of PNAC are compared after 3 weeks of significant administration of lipid emulsion taking into consideration the control over the concomitant factors. Results: 67 patients were included, 35 patients were in the IL group whilst 32 patients were in the SL group. There was no statistical significance between the 2 groups concerning the concomitant factors. After 21 days of being on >= 2g/kg/day of lipid emulsion, the cumulated incidence of PNAC in the IL group was 57% compared to 22% in the SL group. The absolute risk reduction (ARR) of SL is 35.27% whereas the odd ratio (OR) of IL is 4.76. The elevation of conjugated bilirubin and gamma-glutamyl transferase was about 50% less in the SL group but without statistical significance for the latter. Considering the premature surgical neonates, the ARR of SL and the OR of IL failed to prove statistical significance. Conclusion: The incidence and severity of PNAC are less in surgical neonates on SL compared to their counterparts on IL. However, these benefits are unclear in premature surgical neonates. The risk of PNAC in surgical neonates remains the highest, thus consideration of an alternative approach is recommended. |
