Association between congenital heart disease and parenteral nutrition-associated liver disease in neonates: A retrospective cohort study.

Creator(s)

Yasasvhinie Santharam, Children's Mercy HospitalFollow
Christopher R. Nitkin, Children's Mercy HospitalFollow
Ayan Rajgarhia, Children's Mercy HospitalFollow
Alexandra Oschman, Children's Mercy HospitalFollow
Brian R. Lee, Children's Mercy HospitalFollow
Ryan T. Fischer, Children's Mercy HospitalFollow
Keith Feldman, Children's Mercy HospitalFollow

Document Type

Article

Publication Date

5-2023

Identifier

DOI: 10.1002/jpen.2484

Abstract

OBJECTIVE: Infants receiving parenteral nutrition (PN) are at increased risk of PN-associated liver disease (PNALD), which can lead to hepatic fibrosis. Congenital heart disease (CHD) represents a risk factor for hepatic fibrosis, so this study sought to better understand whether infants with CHD were at elevated risk of PNALD when receiving long-term PN.

STUDY DESIGN: This study includes a retrospective cohort of infants at a level IV neonatal intensive care unit from 2010 to 2020 who received long-term PN during the first 8 weeks of life. A time-varying Cox survival model was used to model risk of PNALD between infants with and without CHD, adjusted for demographics, surgical intervention, and PN exposure, using a 5000-iteration bootstrap estimation. Secondary analyses evaluated risk against discrete CHD diagnoses, and sensitivity analysis was performed on the magnitude and quantity of direct bilirubin laboratory measurements making up the PNALD definition.

RESULTS: Neonates with CHD were found to be at higher risk for PNALD during or soon after long-term PN exposure. A pattern of increasing association strength with increasing bilirubin threshold suggests infants with CHD may also experience higher degrees of injury.

CONCLUSIONS: This work offers a step in understanding how diagnoses can be factored into neonate PN prescription. Future work will explore modifications in lipid profiles and timing to mitigate risk in patients with CHD.

Journal Title

JPEN. Journal of parenteral and enteral nutrition

Volume

47

Issue

4

First Page

501

Last Page

510

MeSH Keywords

Infant, Newborn; Infant; Humans; Retrospective Studies; Liver Diseases; Parenteral Nutrition; Bilirubin; Liver Cirrhosis; Heart Defects, Congenital

Keywords

liver disease; neonates; outcomes research/quality; parenteral nutrition

Recommended Citation

Santharam Y, Nitkin CR, Rajgarhia A, et al. Association between congenital heart disease and parenteral nutrition-associated liver disease in neonates: A retrospective cohort study. JPEN J Parenter Enteral Nutr. 2023;47(4):501-510. doi:10.1002/jpen.2484