Total Parenteral Nutrition-Related Cholestasis in Infants

Abstract

An epidemiological study was conducted to estimate the proportion of infants on total parenteral nutrition (TPN) who developed cholestasis and to identify risk factors associated with the development of this disease. Data were abstracted from medical records of 624 infants ≤ 30 days of age who were treated with TPN. A case of TPN-related cholestasis was defined as an infant whose serum level of direct bilirubin was ≥1.5 mg/dl subsequent to initiation of TPN. Risk factors were assessed using multiple logistic regression analysis. Forty-six of 624 infants in the cohort (7.4%) were classified as having TPN-related cholestasis. The multivariable analysis indicated that cholestasis was associated with intracranial hemorrhage, patent ductus arteriosus, sepsis and gastrointestinal conditions that require surgery. Two distinct processes appear to have occurred: (1) in infants who experienced patent ductus arteriosus or intracranial hemorrhage (conditions associated with hypoxia) where TPN may be the necessary trigger for the development of cholestasis, and (2) in infants with gastrointestinal conditions requiring surgery or sepsis, where cholestasis may develop with or without parenteral infusions. (Journal of Parenteral and Enteral Nutrition 10:356-359, 1986)

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References

Peden VH , Witzleben CL , Skelton MA : Total parenteral nutrition. J Pediatr 78:180-181, 1971

Touloukian RJ , Downing SE : Cholestasis associated with long-term parenteral hyperalimentation. Arch Surg 106:58-62, 1973

Rager RR , Finegold MJ : Cholestasis in immature newborn infants: Is parenteral alimentation responsible? J Pediatr 86:264-269, 1975

Touloukian RJ , Seashore JH : Hepatic secretory obstruction with total parenteral nutrition in the infant. J Pediatr Surg 10:353-360, 1975

Rodgers BM , Hollenbeck JI , Donnely WH , et al: Intrahepatic cholestasis with parenteral alimentation. Am J Surg 131:149-155, 1976

Zarif MA , Pildes RS , Szanto PB , et al: Cholestasis associated with administration of amino-acids and dextrose solution. Biol Neonate 29:66-76, 1976

Sondheimer JM Bryan H. , Andrews W. et al: Cholestatic tendencies in premature infants on total parenteral nutrition. Pediatrics 62:984-989, 1978

Hirai Y. , Sanada Y. , Fujwara T. , et al: High calorie infusion-induced hepatic impairments in infants . JPEN 3:146-150, 1979

Postuma R. , Trevenen CL : Liver disease in infants receiving total parenteral nutrition. Pediatrics 63:110-115, 1979

10.

Manginello FP , Javitt NB : Parenteral nutrition and neonatal cholestasis . J Pediatr 94:296-298, 1979

11.

Beale EF , Nelson RM , Bucciarelli RL , et al: Intrahepatic cholestasis associated with parenteral nutrition in premature infants. Pediatrics 64:342-347, 1979

12.

Vileisis RA , Inwood RJ , Hunt CE : Prospective controlled study of parenteral nutrition-associated cholestatic jaundice effect of protein intake. J Pediatr 96:893-897, 1980

13.

Pereira GR , Sherman MS , DiGiacomo J. , et al: Hyperalimentation-induced cholestasis: increased incidence and severity in premature infants. Am J Dis Child 135:842-45, 1981

14.

Dahms BB , Halpin TC : Serial liver biopsies in parenteral nutrition-associated cholestasis of early infancy. Gastroenterology 81:136-144, 1981

15.

Black DD , Suttle EA , Whitington PF , et al: The effect of short-term total parenteral nutrition on hepatic function in the human neonate: A prospective randomized study demonstrating alteration of hepatic canalicular function. J Pediatr 99:445-449, 1981

16.

Farrell MK , Balistreri WF , Suchy FJ : Serum-sulfated lithocholate as an indicator of cholestasis during parenteral nutrition in infants and children. JPEN 6:30-33, 1982

17.

Nakai Landing B. : Factors in the genesis of bile salts in infancy . Pediatrics 27:300-307, 1961

18.

Stein H. , Isaacson C. : Idiopathic cholestasis in the neonatal period. Arch Dis Child 37:63-67, 1961

19.

Hamilton RJ , Sass-Korsak A. : Jaundice associated with severe bacterial infection in young infants. J Pediatr 63:121-132, 1963

20.

Nolan JP : The role of endotoxin in liver injury. Gastroenterology 69:1346-1353, 1975

21.

Utili R. , Abernathy CO , Zimmerman HJ : Minireview: Endotoxin effects on the liver. Life Sci 20:553-568, 1977

22.

Poley R. : Liver and nutrition: Hepatic complications of total parenteral nutrition . IN Textbook of Gastroenterology and Nutrition in Infancy , Lebanthal E (ed). Raven Press, New York, 1981, pp 743-63

23.

Kattwinkel J. : Apnea of prematurity: Pathogenesis and previous forms of therapy. IN Reports of the 71st Ross Conference on Pediatric Research, No. 71-80. Ross Laboratories, Columbus, OH, 1975, pp 19-28

24.

Emmanoulides GC : Persistent patency of the ductus arteriosus in premature infants: Incidence, perinatal factors, and natural history. IN Reports of the 75th Ross Conference on Pediatric Research, No. 71-80. Ross Laboratories, Columbus, OH, 1977, pp 19-28

25.

Volpe JJ : Intraventricular hemorrhage-major neurologic complications of prematurity. IN Reports of the 77th Ross Conferences on Pediatric Research, No. 71-80. Ross Laboratories, Columbus, OH, 1978, pp 27-39

26.

Lebenthal E. : Gastrointestinal disease and nutritional inadequacies . IN Textbook of Gastroenterology and Nutrition in Infancy, Vol 2, Lebenthal E (ed). Raven Press, New York. 1981, pp 979-986