신생아중환자실 환아에서 Total Parenteral Nutrition(TPN) 중의 Heparin 사용지침 평가
Evaluation of Heparin use in Total Parenteral Nutrition in Neonatal Intensive Care Unit
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Abstract
Recently, a number of studies demonstrated that low-dose heparin mightcause heparin-induced thrombocytopenia(HIT). As a result, the guideline of the pediatric nutrition support committee(NSC) of Seoul National University Bungdang hospital states that total parenteral nutrition(TPN) may not include heparin for infants having their birth weight of over1 kg. The purpose of the study is to confirm HIT in pediatric patients and to evaluate the appropriateness of the new guideline regarding heparin use in TPN. Therefore, a retrospective study was carried out using the data contained in the electronic medical record(EMR) of the infants consulted NSC among the pediatric patients admitted to the neonatal intensive care unit(NICU) from March of 2006 to August of 2007. Basal/lowest platelet counts and serum triglyceride concentrations as well as general demographic characteristics of the patients were collected from the EMR database. For the case of the confirmation of HIT, total 67 patients were enrolled in the study. Amongst those, 36 patients were assigned as 'before group'(i.e., before the revision of the guideline) while 31 patients assigned as 'after group'(i.e., after the revision of the guideline). The differences of the basal and the lowest platelet counts between the two groups were not statistically significant(i.e., the basal platelet count, 255.8±96.0 and 218.8±76.8*103/㎕ for before group and after group, respectively, p=0.15; the lowest platelet count, 204±115.8 and 199.6±83.7*103/㎕ for before group and after group, respectively, p=0.88). For the case of the appropriateness study, the total number of infants enrolled was 77. The increase in the serum triglyceride concentration and the decrease in the lipid amount administered were more pronounced inpatients who stopped using heparin than in those who have not used heparin or who continued to use heparin(4 vs. 0 vs. 0; 3 vs. 0 vs. 1). Because of the limited number of patients, the conclusion cannot be drawn at this point. However, since there was a slight possibility of HIT, it is recommended that the use of heparin should be limited in TPN for neonates.
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