J Korean Assoc Pediatr Surg.  2015 Jun;21(1):1-6. 10.13029/jkaps.2015.21.1.1.

Associated Factors with Parenteral Nutrition Associated Cholestasis in Neonates

  • 1Department of Surgery, Inje University Haeundae Paik Hospital, Busan, Korea.
  • 2Department of Pediatrics, Inje University Haeundae Paik Hospital, Busan, Korea.
  • 3Department of Surgery, Dong-A University College of Medicine, Busan, Korea. d011029@naver.com


Long time total parenteral nutrition (TPN) can induce irreversible liver damage. In this study, we investigated the associated factors of parenteral nutrition associated cholestasis (PNAC) in neonates.
We retrospectively reviewed 227 neonates (male:female=110:117) those who had received TPN over 2 weeks from March 2010 to February 2014. PNAC was defined as direct bilirubin was higher than 2.0 mg/dL without any cause except TPN.
Overall incidence was 28.6%. PNAC was frequently developed in younger gestational age with lower birth weight. Episodes of sepsis, underlying bronchopulmonary dysplasia, history of necrotizing enterocolitis, and experience of gastrointestinal surgery increase the incidence of PNAC. PNAC was directly associated the duration of TPN and long period to full enteral feeding, reaching 60 and 150 mL/kg/day. Overall mortality rate was 9.7%. It was higher in PNAC group despite PNAC was not the primary cause of death. All survivors were recovered from cholestasis with encourage of enteral nutrition.
PNAC in neonate was associated with younger gestational ages and lower birth weights, duration of TPN, or who experienced sepsis, necrotizing enterocolitis, gastrointestinal surgery or bronchopulmonary dysplasia.


Newborn infant; Parenteral nutrition; Cholestasis

MeSH Terms

Birth Weight
Bronchopulmonary Dysplasia
Cause of Death
Enteral Nutrition
Enterocolitis, Necrotizing
Gestational Age
Infant, Newborn*
Parenteral Nutrition*
Parenteral Nutrition, Total
Retrospective Studies


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