The effectiveness of serum amyloid A for prediction of neonatal cholestasis associated with parenteral nutrition in premature infants

Özet

Parenteral nutrition (PN) has been widely used in premature infants untillenteral feeding can be tolerated. Cholestasis is an important complication ofPN. The objective of this study was to evaluate the role of serial measurementsof serum amyloid A (SAA) during PN and compare its’ effectiveness withC-reactive protein (CRP) and procalcitonin (PCT). We also aimed to determinethe risk factors for PN associated cholestasis (PNAC).Premature infants (<34 weeks’ gestational age) who were started on PNduring hospitalization were included in this prospective study. SAA, CRP andPCT levels were measured on days 0, 3, 7, 14, and 21 of PN in all infants.Infants who had PN for less than 2 weeks, who developed sepsis and/ornecrotizing enterocolitis were excluded.A total of 85 infants were included. The mean birth weight was 1226±329g, and the mean gestational age was 29.4±1.8 weeks. The birth weight ofinfants who developed cholestasis were significantly lower. Enteral nutritionwas started significantly later in infants with cholestasis. CRP and PCT didnot correlate with conjugated bilirubin levels at any time point. SAA levelson days 7 and 14 showed a significant correlation with conjugated bilirubinlevels. SAA levels on day 7 was found to have the highest sensitivity forprediction of PNAC.Low birth weight, late commencement of enteral feeding, and prolonged PNwere the main risk factors for PNAC development. This is the first studythat shows the predictive value of SAA for PNAC development. We suggestthat SAA may be used as an accurate and useful biomarker for predictionof PNAC in high risk premature infants receiving PN.