الفهرس 
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Abstract
We aimed in our work to find the correlation between receiving TPN as the main source of nutrition in early neonatal life of ill neonates admitted to NICU shortly after birth and incidence of cholestasis and also to assess the correlaion between the duration of parenteral nutrition and the development of parenteral nutrition associated cholestasis , also the effect of using ursodeoxycholic acid (UDCA) and early initiation of enteral on resolution of cholestasis .
Babies of both gender, of gestational age ranging from 28-39 weeks while on TPN within the 1st week of life were included in our study.
We classified our cases into 2 groups ( cholestatic , non- cholestatic) according to their direct serum bilirubin level , into cholestatic group (n=36, 23.1%) with DSB higher than 20% of TSB and non-cholestatic group (n=120, 71.9%) with DSB lower than 20% of TSB through their illness.
In our study, we re-subdivided our cholestatic group (n= 36) according to their blood cultures during the attack of cholestatsis into (n=8, 5.2%) with positive blood cultures and (n=28, 17.9%) with negative blood cultures.
Parenteral nutrition associated cholestasis was not highly prevalent in our patient population, with only 23.1% .
Our results revealed that on comparing duration of TPN between our 2 groups ( cholestatic, non-cholestatic) , there was highly statistically significant difference found with (p=0.014), revealing that prolonged duration of parenteral nutrition increased the risk of parenteral nutrition associated cholestasis.
On comparing doses of TPN components regarding protiens and lipids between our 2 groups( cholestatic , non-cholestatic), we found that there was highly significant difference with (p=0.009) as cholestatic group was on higher doses of both proteins and lipids.
We also found that the best cut off point for dose of proteins to develop cholestasis is 2.9 gm/kg/day with sensitivity of 58.3%, specificity of 62.5% and AUC of 63.7%, while for doses of lipids, the best cut off is 1.5gm/kg/day with sensitivity of 80.56%, specificity of 36.67% and AUC of 61.3%.
On comparing timing of initiation of enteral feeding between our 2 groups (cholestatic , non-cholestatic) , we found that there was a high association between early initiation of entral feeding and decrease incidence of choletasis when starting enteral feeding within 1st week of life while on TPN .
Among our cholestatic group, on comparing efficacy of medical treatment ursodeoxycholic acid [UDCA 10mg/kg/day] on our cases outcome, there was a significant correlation between receiving UDCA and resolution of cholestasis with (p=0.007).
By univariate logistic regression analysis we found that there was statistically significant association between increasing incidence of cholestasis and duration of TPN, doses of proteins and lipids, while early initiation of enteral feeding deceasing the incidence of cholestatsis and improving the outcome of our cases , these predictors might be useful tools to clinically predict the development of cholestasis. Of these predictors, the duration of parenteral nutrition was the most significant risk factor for parenteral nutrition associated cholestasis.