Increased incidence of parental nutrition-associated cholestasis with aminosyn PF compared to Trophamine

Kelly Wright, Kimberly D. Ernst, Mark Gaylord, Joan P. Dawson, Tara Burnette

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objective: To compare the incidence of parenteral nutrition-associated cholestasis (PNAC) between two pediatric parenteral amino-acid formulations, Aminosyn PF (APF) and Trophamine (TA). Study Design: Setting: Tertiary newborn intensive-care nursery. Subjects: A total of 661 neonates who received either TA or APF. Design: Retrospective. The incidence of PNAC was determined in three groups: Group I (TA, 8/19/97 to 8/19/98, n = 335), Group II (APF, 8/20/98 to 1/28/99, n = 157), and Group III (TA, 1/29/99 to 8/1/99, n = 169). Results: No PNAC developed in any infant receiving parenteral nutrition (PN) for <3 weeks. Of 141 patients given PN for ≥ 21 days, 24 were diagnosed with PNAC: Group I (TA, 10/78, 12.8%), Group II (APF, 9/27,33.3%), and Group III (TA, 5/36, 13.9%). The incidence of PNAC was significantly higher in infants who received APF (p = 0.043.) Using logistic regression, only birth weight, duration of PN, and use APF were significant risk factors for the development of PNAC. Despite an earlier initiation of enteral feedings, APF recipients developed PNAC sooner, had higher peak direct bilirubin levels, and remained jaundiced longer. Conclusions: The use of APF was temporally associated with a greater than two-fold increase in the incidence of PNAC compared to periods of exclusive TA use. In the absence of significant differences in parenteral nutrient or energy intake in neonates who developed PNAC, we speculate that possible differences between the amino-acid compositions of TA and APF may be responsible for the observed differences in the incidence of PNAC.

Original languageEnglish (US)
Pages (from-to)444-450
Number of pages7
JournalJournal of Perinatology
Volume23
Issue number6
DOIs
StatePublished - Sep 1 2003

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Cholestasis
Parenteral Nutrition
Incidence
amino-acid, glucose, and electrolyte solution
Newborn Infant
Amino Acids
Nurseries
Enteral Nutrition
Critical Care
Jaundice
Energy Intake
Bilirubin
Birth Weight

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Increased incidence of parental nutrition-associated cholestasis with aminosyn PF compared to Trophamine. / Wright, Kelly; Ernst, Kimberly D.; Gaylord, Mark; Dawson, Joan P.; Burnette, Tara.

In: Journal of Perinatology, Vol. 23, No. 6, 01.09.2003, p. 444-450.

Research output: Contribution to journalArticle

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abstract = "Objective: To compare the incidence of parenteral nutrition-associated cholestasis (PNAC) between two pediatric parenteral amino-acid formulations, Aminosyn PF (APF) and Trophamine (TA). Study Design: Setting: Tertiary newborn intensive-care nursery. Subjects: A total of 661 neonates who received either TA or APF. Design: Retrospective. The incidence of PNAC was determined in three groups: Group I (TA, 8/19/97 to 8/19/98, n = 335), Group II (APF, 8/20/98 to 1/28/99, n = 157), and Group III (TA, 1/29/99 to 8/1/99, n = 169). Results: No PNAC developed in any infant receiving parenteral nutrition (PN) for <3 weeks. Of 141 patients given PN for ≥ 21 days, 24 were diagnosed with PNAC: Group I (TA, 10/78, 12.8{\%}), Group II (APF, 9/27,33.3{\%}), and Group III (TA, 5/36, 13.9{\%}). The incidence of PNAC was significantly higher in infants who received APF (p = 0.043.) Using logistic regression, only birth weight, duration of PN, and use APF were significant risk factors for the development of PNAC. Despite an earlier initiation of enteral feedings, APF recipients developed PNAC sooner, had higher peak direct bilirubin levels, and remained jaundiced longer. Conclusions: The use of APF was temporally associated with a greater than two-fold increase in the incidence of PNAC compared to periods of exclusive TA use. In the absence of significant differences in parenteral nutrient or energy intake in neonates who developed PNAC, we speculate that possible differences between the amino-acid compositions of TA and APF may be responsible for the observed differences in the incidence of PNAC.",
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N2 - Objective: To compare the incidence of parenteral nutrition-associated cholestasis (PNAC) between two pediatric parenteral amino-acid formulations, Aminosyn PF (APF) and Trophamine (TA). Study Design: Setting: Tertiary newborn intensive-care nursery. Subjects: A total of 661 neonates who received either TA or APF. Design: Retrospective. The incidence of PNAC was determined in three groups: Group I (TA, 8/19/97 to 8/19/98, n = 335), Group II (APF, 8/20/98 to 1/28/99, n = 157), and Group III (TA, 1/29/99 to 8/1/99, n = 169). Results: No PNAC developed in any infant receiving parenteral nutrition (PN) for <3 weeks. Of 141 patients given PN for ≥ 21 days, 24 were diagnosed with PNAC: Group I (TA, 10/78, 12.8%), Group II (APF, 9/27,33.3%), and Group III (TA, 5/36, 13.9%). The incidence of PNAC was significantly higher in infants who received APF (p = 0.043.) Using logistic regression, only birth weight, duration of PN, and use APF were significant risk factors for the development of PNAC. Despite an earlier initiation of enteral feedings, APF recipients developed PNAC sooner, had higher peak direct bilirubin levels, and remained jaundiced longer. Conclusions: The use of APF was temporally associated with a greater than two-fold increase in the incidence of PNAC compared to periods of exclusive TA use. In the absence of significant differences in parenteral nutrient or energy intake in neonates who developed PNAC, we speculate that possible differences between the amino-acid compositions of TA and APF may be responsible for the observed differences in the incidence of PNAC.

AB - Objective: To compare the incidence of parenteral nutrition-associated cholestasis (PNAC) between two pediatric parenteral amino-acid formulations, Aminosyn PF (APF) and Trophamine (TA). Study Design: Setting: Tertiary newborn intensive-care nursery. Subjects: A total of 661 neonates who received either TA or APF. Design: Retrospective. The incidence of PNAC was determined in three groups: Group I (TA, 8/19/97 to 8/19/98, n = 335), Group II (APF, 8/20/98 to 1/28/99, n = 157), and Group III (TA, 1/29/99 to 8/1/99, n = 169). Results: No PNAC developed in any infant receiving parenteral nutrition (PN) for <3 weeks. Of 141 patients given PN for ≥ 21 days, 24 were diagnosed with PNAC: Group I (TA, 10/78, 12.8%), Group II (APF, 9/27,33.3%), and Group III (TA, 5/36, 13.9%). The incidence of PNAC was significantly higher in infants who received APF (p = 0.043.) Using logistic regression, only birth weight, duration of PN, and use APF were significant risk factors for the development of PNAC. Despite an earlier initiation of enteral feedings, APF recipients developed PNAC sooner, had higher peak direct bilirubin levels, and remained jaundiced longer. Conclusions: The use of APF was temporally associated with a greater than two-fold increase in the incidence of PNAC compared to periods of exclusive TA use. In the absence of significant differences in parenteral nutrient or energy intake in neonates who developed PNAC, we speculate that possible differences between the amino-acid compositions of TA and APF may be responsible for the observed differences in the incidence of PNAC.

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