目的：全靜脈營養 (total parenteral nutrition, TPN) 在新生兒領域已使用多年，是早產兒治療的重點關鍵治療之一。使用 TPN 大於 14 天的早產兒，會產生相關併發症，其中以靜脈營養併發膽汁鬱積 (parenteral nutrition-associated cholestasis, PNAC) 最為常見且嚴重，部分早產兒可能會進一步發展為膽汁鬱積性肝硬化，肝功能衰竭。PNAC 定義為 TPN 使用 14 天以上，直接膽紅素 (direct bilirubin) 持續高出標準值 ( ≥ 2mg/dL)。
方法：本研究收集 2019 年 1 月至 2020 年 12 月臺灣南部某醫學中心使用 TPN超過 14 天之早產兒。回溯性觀察早產兒使用 TPN 的時機、天數和其性別、胎齡(gestational age, GA)、阿普伽評分 (Apgar score, AS)、出生體重 (body weight, BW)，並連結早產兒住院期間直接膽紅素 (mg/dL) 的檢驗值進行分析。探討早產兒長期使用TPN，各種相關因素對膽汁鬱積發生率的影響。
結果：納入分析者共 74 人，膽汁鬱積的發生率為 20%。各種相關因素的平均值分別為 GA：PNAC 組 28.20 ± 3.44 週，non-PNAC 組 30.22 ± 2.34 週 (p = 0.0089) ﹔第 1 分鐘 AS：PNAC 組 6.20 ± 1.01，non-PNAC 組 6.51 ± 1.56 (p = 0.4697)；第 5 分鐘 AS：PNAC 組 8.20 ± 0.68，non-PNAC 組 8.49 ± 0.80 (p = 0.1969)；BW：PNAC 組1,056.67 ± 381.88 g，non-PNAC 組 1,276.83 ± 341.13 g (p = 0.0326)；TPN 使用天數：PNAC 組 76.87 ± 39.78 天，non-PNAC 組 28.08 ± 11.48 天 (p < 0.001)；脂質 (lipid) 開始使用的年齡：PNAC 組 7.4 ± 7.3 天，non-PNAC 組 5.77 ± 3.78 天 (p = 0.2375)；脂質使用天數：PNAC 組 52.93 ± 25.31 天，non-PNAC 組 21.12 ± 12.08 天 (p < 0.001)。
結論：對於早產兒而言，較小的 GA、較低的 BW 和長期使用 TPN 皆會增加發生膽汁鬱積的風險，因此使用期間需要同時監控生長情況、相關檢驗數據和臨床症狀，才能達到治療效果。

Objective: Total parenteral nutrition (TPN) is widely used for nutritional support in preterm infants. Parenteral nutrition-associated cholestasis (PNAC), a well-known complication of prolonged TPN in preterm infants, is defined as TPN administration over > 14 days with serum direct bilirubin levels consistently > 2 mg/dL.
Methods: This retrospective study performed at a medical center in southern Taiwan from January 2019 to December 2020 included preterm infants who received TPN over > 14 days. We analyzed infants’ gender, gestational age, Apgar scores (AS), birth weight (BW), serum direct bilirubin levels, and duration of TPN administration (in days) during hospitalization. We investigated the association between long-term TPN administration and the incidence of cholestasis in these infants.
Results: The study included 74 preterm infants. Comparison between the PNAC and non-PNAC groups showed the following results: The mean gestational age was 28.20 ± 3.44 weeks vs. 30.22 ± 2.34 weeks (p = 0.0089), the 1-min AS were 6.20 ± 1.01 vs. 6.51 ± 1.56 (p = 0.4697), the 5-min AS were 8.20 ± 0.68 vs. 8.49 ± 0.80 (p = 0.1969), BW was 1,056.67 ±381.88 g vs. 1,276.83 ± 341.13 g (p = 0.0326), and the mean duration of TPN use (in days) was 76.87 ± 39.78 days vs. 28.08 ± 11.48 days (p < 0.001).
Conclusions: Small-for-gestational-age status, low BW, and prolonged TPN administration tend to increase the risk of cholestasis in premature infants, and close monitoring of growth, the relevant laboratory data, and clinical symptoms are important to ensure an optimal therapeutic effect of TPN.