Cyclic Parenteral Nutrition and Cholestasis in Neonates with Gastroschisis

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Cyclic Parenteral Nutrition and Cholestasis in
Neonates with Gastroschisis

• Aaron R Jensen MD MEd, Adam B Goldin MD MPH,
• Joseph S Koopmeiners MS, John HT Waldhausen MD,
• and Stephen S Kim MD

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Background

• PNAC Parenteral Nutrition Associated
  Cholestasis
• Direct Bilirubin gt 2.0
• Incidence
• 67 at 3 months of PN exposure in neonates
• Multifactorial etiology
• Cyclic PN may be beneficial

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Study Design

• Hypothesis The use of prophylactic cyclic PN is
  associated with a decreased incidence and delayed
  onset of PNAC
• Retrospective chart review
• Single center
• 1996-2007
• Study population Patients with Gastroschisis
• Relatively few comorbidities/confounding factors
• Prolonged course of PN

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Definitions

• Prophylactic Cyclic PN
• Intentional interruption in parenteral nutrition
• Occurred prior to the onset of hyperbilirubinemia
  (Direct Bilirubin gt 2.0)
• Initiated in stable patients
• Goal 4 hours off of PN daily

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Study Population
Gastroschisis Initial Admission N114
Suitable for Analysis N107
Prophylactically Cycled N36
Continuous PN (Control) N71
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Results Patient Characteristics
p lt 0.01
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Results Cumulative Incidence

• Cumulative Incidence
• Odds Ratio 4.8 (95 CI 1.6-14.0)

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Results Confounding Factors
n8
n15
Percent Enteral Feeding
n12
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Limitations

• Retrospective Study
• Cycling not standardized
• Group assignment bias
• Large confidence interval
• Gastroschisis population

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Conclusions

• Prophylactic cyclic PN may be beneficial in
  delaying the onset of PNAC in patients with
  Gastroschisis
• Future prospective randomized study is warranted