2009 Southern Regional Meeting Abstracts

Purpose of Study: To define the natural history of cholestasis in ELBW infants in a university, level III nursery.
Methods Used: Case-control cohort of infants receiving parenteral amino acids within the first 24 hours of life. Thirty cholestatic infants (conjugated bilirubin > 2.1 mg/dL) were matched with controls by BW±150 g and gestational age (GA)±2 weeks. Inclusion criteria: birth weight (BW) <1 kg, admission to NICU < 24 hrs after birth, TPN provided ≧5 days, survival ≧7 days. Exclusion criteria: Major congenital anomalies and surgery within the first 5 days of life. Data analyzed included patient characteristics and clinical course. Numeric data were analyzed by paired T-test; categorical data by Chi square. Mann-Whitney U test was used for non-normally distributed data. Statistical significance was set at p<0.05.
Summary of Results: Cholestatic infants (CI) were lighter (683±153g v. 752±125g, (0.008)), more premature (25.4±2.1 wk v. 26.2±2.0 wk, (0.014)), and more ill than controls. These infants had higher SNAPPE scores (49.2±18.4 v. 33.3±14.6 (<0.001)), lower APGARS (6.3±1.8 v. 7.4±1.4 (0.017)), longer time on assisted ventilation (56 (38, 78) v. 38.0 (24, 38) days (0.003)), more likely to have IVH (53.30% v. 26.70% (0.032)), and required more days of Dopamine (6 (4, 9) v. 2 (1, 5) (0.002)). CI received more days of TPN (59.5±79d v. 27.6±13.6d (0.039)), were older when enteral feeds started (13.3±8.6d v. 9±5.2d (0.02)), had more days of central/peripheral access, and interruptions of feeding than control infants. Direct bilirubin levels were improving or normalized by discharge (3.5±2.2 mg/dL). The CI mortalities all suffered from NEC and none had liver failure.
Conclusions: ELBW infants are at risk for TPNAC because of prematurity and associated complications. In this cohort of 30 children, conjugated hyperbilirubinemia had a self-resolving course. Most of the morbidity in these infants was early in life as indicated by SNAPPE score and hypotension and not from the use of TPN. The observed cholestatic infant mortalities were secondary to NEC and not liver failure.