511 TOTAL PARENTERAL NUTRITION-RELATED CHOLESTASIS IN INFANTS

This study estimated the proportion of infants on total parenteral nutrition (TPN) who developed cholestasis. Risk factors associated with the development of this disease were identified. Data were abstracted from medical records of 624 infants ≤30 days of age who were treated with TPN. A case of TPN-related cholestasis was defined as an infant whose serum level of direct bilirubin was ≥1.5 mg/dl subsequent to initiation of TPN. Risk factors were assessed using multiple regression logistic analysis. Forty-six of the 624 infants in the cohort (7.4%) were classified as having TPN-related cholestasis. Even though the proportion of infants with TPN-related cholestasis was small, specific risk factors were identified. The multivariable analysis indicated that cholestasis was associated with intracranial hemorrhage (IH) and patent ductus arteriosus (PDA), conditions seen primarily in premature infants, and with sepsis and gastrointestinal (GI) conditions requiring surgery, seen in both term and preterm infants. Two distinct processes appear to have occurred: 1) in infants who experienced PDA or IH (conditions associated with hypoxia) where TPN may be the necessary trigger for the development of cholestasis, and 2) in infants with GI surgical conditions or sepsis, where cholestasis may develop with or without parenteral infusions.