Klein et al reported risk factors for parenteral nutrition-associated cholestasis (PNAC) in newborn infants receiving parenteral nutrition. The authors are from Children's National Medical Center and George Washington University.


Synonym: parenteral nutrition-associated conjugated hyperbilirubinemia


Criteria for PNAC:

(1) infant receiving parenteral nutrition

(2) serum direct bilirubin >= 2 mg/dL

(3) no other explanation for the hyperbilirubinemia


Risk factors associated with the patient:

(1) prematurity

(2) birth weight < 750 g

(3) small for gestational age

(4) bronchopulmonary dysplasia

(5) gastroschisis

(6) jejunal atresia

(7) necrotizing enterocolitis

(8) late-onset neonatal sepsis


Risk factors associated with the parenteral nutrition:

(1) higher cumulative dose of amino acids

(2) type of amino acids administered

(3) prolonged use (typically >= 3 weeks)

(4) di-(2-ethylhexyl)phthalate as plasticizer for tubing

(5) tubing made with polyvinylchloride


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