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Marcel J. I. J. Albers, MD; Dana-Anne H. de Gast-Bakker, MD; Nicolette A. M. van Dam, MD; Gerard C. Madern, MD; Dick Tibboel, PhD

Arch Surg. 2002;137:789-793.

Hypothesis  Sepsis is an epiphenomenon of parenteral nutrition–associated cholestasis (PNAC) and not a causative factor, and the incidence of sepsis is not affected by the presence or absence of PNAC.

Design  Observational cohort study.

Setting  Pediatric surgery department in a tertiary referral children's hospital.

Patients  Newborns receiving PN for at least 7 days following intestinal surgery.

Main Outcome Measures  The criteria for PNAC were as follows: PN for at least 14 consecutive days, conjugated bilirubin level greater than 1.5 mg/dL (>26 µmol/L), conjugated bilirubin fraction greater than 50%, and absence of another identifiable cause of cholestasis. The identification of septic events was based on Centers for Disease Control and Prevention criteria.

Results  The patients (26 with PNAC and 72 without PNAC) were well comparable for underlying disease, gestational age, birth weight, and age at the start of PN. Time receiving PN and length of hospital stay were significantly (P<.001) longer in patients with PNAC. Parenteral nutrition–associated cholestasis was associated with male sex (P = .03; odds ratio, 2.8; 95% confidence interval, 1.1-7.1). The overall sepsis incidence was low (9 per 1000 hospital days). The sepsis incidence tended to be higher in patients with PNAC than in patients without PNAC (11.8 vs 7.1 per 1000 days; P = .08), but was significantly higher in male than in female patients (12.2 vs 5.6 per 1000 days; P = .01). Most septic events were caused by coagulase-negative staphylococci.

Conclusions  Sepsis is an epiphenomenon of PNAC rather than a causative factor. Moreover, male sex predisposes the newborn surgical patient to PNAC and to sepsis.

From the Department of Pediatric Surgery, Sophia Children's Hospital/Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands. Dr Albers is now affiliated with the Division of Intensive Care, Department of Pediatrics, Beatrix Children's Clinic, University Hospital Groningen, Groningen, the Netherlands.