Published online Nov 8, 2016. doi: 10.5409/wjcp.v5.i4.365
Peer-review started: June 3, 2016
First decision: July 25, 2016
Revised: September 20, 2016
Accepted: October 22, 2016
Article in press: October 24, 2016
Published online: November 8, 2016
To determine if packed red blood cell transfusions contribute to the development of parenteral nutrition associated liver disease.
A retrospective chart review of 49 premature infants on parenteral nutrition for > 30 d who received packed red blood cell (PRBC) transfusions was performed. Parenteral nutrition associated liver disease was primarily defined by direct bilirubin (db) > 2.0 mg/dL. A high transfusion cohort was defined as receiving > 75 mL packed red blood cells (the median value). Kaplan-Meier plots estimated the median volume of packed red blood cells received in order to develop parenteral nutrition associated liver disease.
Parenteral nutritional associated liver disease (PNALD) was noted in 21 (43%) infants based on db. Among the 27 high transfusion infants, PNALD was present in 17 (64%) based on elevated direct bilirubin which was significantly greater than the low transfusion recipients. About 50% of the infants, who were transfused 101-125 mL packed red blood cells, developed PNALD based on elevation of direct bilirubin. All infants who were transfused more than 200 mL of packed red blood cells developed PNALD. Similar results were seen when using elevation of aspartate transaminase or alanine transaminase to define PNALD.
In this retrospective, pilot study there was a statistically significant correlation between the volume of PRBC transfusions received by premature infants and the development of PNALD.
Core tip: The etiology of parenteral nutrition associated liver disease (PNALD), a commonly encountered morbidity in the neonatal intensive care unit (NICU) remains unknown. Potentially hepatotoxic packed red blood cell (PRBC) transfusions are routinely administered in this setting. Whether PRBC transfusions increase the prevalence of PNALD is a clinical question that has not been systematically investigated. This pilot study demonstrated that in a cohort of NICU infants who received greater volumes of PRBC, there was a significantly higher prevalence of PNALD. Further investigations to define the exact risk are warranted to minimize NICU stays, costs, and future liver damage.