648 - Morbidity and discharge outcomes of neonatal cholestasis: a multi-centre cross-sectional study in China

Publication Number: 1625.648

Mingyan Hei, Beijing Chidlren's Hospital, Capital Medical University, Beijing, Beijing, China (People's Republic); Lu Chen, Beijing Children's Hospital, Beijing, Beijing, China (People's Republic)

Background: There was no report on the incidence and outcomes of neonatal cholestasis at a nationwide level in China.

Objective: To investigate the morbidity and discharge outcomes of neonatal cholestasis at a nationwide multi-center level in China.

Design/Methods: This was a retrospective, multi-centre, cross-sectional study with 69 children's hospitals in 31 provinces across China participated. The study period was from January 01, 2016 to December 231, 2022. Data were extracted from the front page of digital medical history record system of each hospital. Newborns with discharge diagnosis of "neonatal cholestasis" ([ICD-10] code P78.8) or "cholestasis" (ICD-10 code K83.1) were enrolled. Patients were excluded if information of gender or admission age or weight was missing. Patients were categorized into two groups, cholestasis with or without liver dysfunction (ICD-10 R94.5 for liver dysfunction, and ICD-10 K72.9 for liver failure). Demographic data, etiologies, and discharge outcomes were collected. JMP Pro 17 was used for statistical analysis.

Results: A total of 8915 neonates were enrolled (Figure 1). Based on a total of 837184 neonates admitted at the same time period, the morbidity rate of neonatal cholestasis was 1.06%. From 2016 to 2022, the annual morbidity rate was 0.31%, 0.45%, 0.73%, 0.90%, 1.66%, 2.14%, and 2.03%, respectively, representing a significantly increasing trend (Z = 58.1587, P < 0.001) (Figure 2). The admission age was 6 (0, 16) days, and the total hospital stay was 15 (7, 39) days. The mortality rate was 0.30%. A total of 1,357 (15.22%) patients were discharged against medical advice. The etiologies included infection (2796/8915, 31.36%), endocrine disorders (598/8915, 6.71%), inborn errors of metabolic/genetic disorders (252/8915, 2.83%), and extrahepatic obstruction (215/8915, 2.41%). Multivariate logistic regression analysis revealed that extrahepatic obstruction (adjusted odds ratio [aOR]: 4.74), infection (aOR: 2.77), and inborn errors of metabolic/genetic disorders (aOR: 1.78) were independent risk factors for neonatal cholestasis with abnormal liver function. Demographics, clinical features and discharge outcomes of neonatal cholestasis with or without liver dysfunction were listed in table below.

Conclusion(s): The morbidity rate of neonatal cholestasis in China was in a significantly increasing trend over the past years. The high rate of discharge against medical advice for neonates with cholestasis raises significant concerns in China.

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Annual morbidity of neonatal cholestasis in China from 2016 to 2022
From 2016 to 2022, the annual admissions for neonatal cholestasis were 437, 623, 967, 1,216, 1,759, 2,086, and 1,827, accounting for 0.31%, 0.45%, 0.73%, 0.90%, 1.66%, 2.14%, and 2.03% of the total admissions in each year, respectively, representing a significantly increased ratio (Z = 58.1587, P < 0.001) .

Neonatal cholestasis with or without liver dysfunction (N=8915)