Relationship Between Total Parenteral Nutrition, Ventilation, and
Hepatoblastoma: A Study of 293,681 Neonatal Intensive Care Unit
Admissions
Abstract
Introduction Hepatoblastoma has a low annual incidence
(1.7/1,000,000 children) posing a barrier to studying epidemiologic risk
factors in its development. Current accepted associations include low
birthweight and overgrowth syndromes. Neonatal intensive care unit
(NICU) interventions were evaluated for the relationship with subsequent
development of hepatoblastoma. Methods Pediatric Health
Information System data between 2016-2022 was queried for all NICU
admissions. From this set, patients with a diagnosis code for
hepatoblastoma were identified. Pharmacy billing information was used to
calculate total number of days of total parenteral nutrition (TPN) and
mechanical ventilation exposure during NICU hospitalization.
Results 293,681 patients met inclusion, with 51 patients
diagnosed with hepatoblastoma. Logistic regression demonstrated that
every 10 additional days of TPN (OR 1.10, 95% CI 1.00-1.13) or
mechanical ventilation (OR 1.08, 95% CI 1.06-1.09) was correlated with
increased likelihood of development of hepatoblastoma. The dataset was
partitioned into two samples, one for training and the other for
validation. TPN and duration of mechanical ventilation were the retained
predictors within the training sample following least absolute shrinkage
and selection operator analysis. Using these retained predictors within
the validation sample, there were 773 patients with a predicted
probability of developing hepatoblastoma greater than 0.05%, with 6
patients who developed hepatoblastoma (0.78%). Discussion A
cohort of infants were identified as having a risk for the subsequent
development of hepatoblastoma, similar to that of patient with known
associated syndromes. A predictive model was created to assist in
identifying patients who may benefit from screening based upon specific
NICU exposures.