단일 상급종합병원에서 PNAC 소아 환자 치료 현황

Abstract

Background : Parenteral nutrition-associated cholestasis (PNAC) may occur in neonates and pediatric patients receiving long-term parenteral nutrition (PN). This study aimed to provide a real-world data analysis of treatment status of PNAC patients under 12 years in clinical practice. Methods : A retrospective analysis was conducted from January 2015 to December 2022 on pediatric patients diagnosed with PNAC aged less than 12 years who were admitted to the hospital. These patients received parenteral nutrition for two weeks or more. Implementation rates of various treatment methods, changes in liver function, nutrition-related test results after initiation of treatment, and duration of treatment were examined. Results : This study included 38 patients (24 neonates, 10 infants, and 4 children). The primary diagnosis was prematurity, observed in 19 (50.0%) cases. Comorbidities included patent ductus arteriosus (25 cases, 65.8%) and sepsis (19 cases, 50.0%). Various methods were employed for treating PNAC. 37 (97.4%) patients received ursodeoxycholic acid (UDCA). 24 (63.2%) patients had total caloric and nutritional compositions of PN changed. 18 (47.4%) patients had PN discontinued. 16 (42.1%) patients received EN. 7 (18.4%) patients received cyclic PN and 2 (5.3%) patients received 100% fish oil lipid emulsions. On average, each patient underwent 2.9 different treatment methods simultaneously. Direct bilirubin level at the time of PNAC diagnosis was 3.7 mg/dL. After 7 weeks of treatment, 20 (52.6%) patients showed recovery from PNAC. The median duration of PNAC treatment was 29.0 days (range, 5.0-200.0 months). Conclusion : This study examined implementation rates of various treatment methods for pediatric PNAC patients and investigated their effects on liver function and changes in nutritional supply. Findings of this study suggest that future research addressing limitations of this study may provide meaningful treatment approaches for PNAC.