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[Liver complications associated with short-term parenteral nutrition in children]
J M Moreno Villares1, P Gomis Muñoz, M J Galiano Segovia
1Unidad de Nutrición Clínica, Hospital Doce de Octubre, Madrid.
Insights
More than half of children on parenteral nutrition (PN) develop liver dysfunction (LD). Avoiding infection and minimizing PN duration are key to preventing this common complication in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Metabolic Complications
Context:
- Parenteral nutrition (PN) is essential for pediatric patients unable to receive enteral feeding.
- Liver dysfunction (LD) is a frequent metabolic complication associated with PN in children.
- Understanding the prevalence and risk factors for LD in this population is crucial for patient management.
Purpose:
- To estimate the prevalence of liver dysfunction (LD) in children receiving short-term parenteral nutrition (PN).
- To identify risk factors associated with the development of PN-related LD in pediatric patients.
- To inform clinical strategies for preventing and managing LD in children on PN.
Summary:
- This retrospective study analyzed 94 children receiving PN, defining LD by elevated liver function tests (ALT, GGT, total bilirubin).
- Liver dysfunction (LD) was observed in 54% of children, typically appearing within the second week of PN.
- Increased length of PN and the presence of sepsis were significantly associated with LD, while age, nutritional status, and PN composition did not show a significant influence.
Impact:
- Early identification and management of LD in pediatric patients on PN can improve outcomes.
- Findings suggest that strategies to reduce the duration of PN and prevent sepsis are critical in mitigating LD risk.
- This research highlights the need for vigilant monitoring of liver function in children undergoing PN therapy.
Objective:
Liver dysfunction (LD) with abnormalities in biochemical liver function tests is the most common metabolic complication of parenteral nutrition (PN). The aim of this study was to estimate the prevalence of LD in children receiving short-term PN and to identify risk factors.
Patients And Methods:
Data were gathered retrospectively during a 2-year period. Ninety-four children older than 28 days received PN (mean age 5.4 +/- 5.1 years). PN related LD was defined as when serum levels of one or more of the following liver function tests were increased: ALT > or = 80 IU/L, GGT > or = 120 IU/L and total bilirubin > or = 1.8 mumol/L. Children with previous liver disease were excluded (n = 17), as well as those with incomplete data (n = 16).
Results:
LD was present in 33 children (54%). The incidence rate was 5.8 cases/100 patient days of PN. It started 9.8 +/- 6.9 days after beginning PN. The nadir appeared during the second week of PN. The following variables did not appear to significantly influence the presence of PN: age, gender, nutritional status, PN caloric load or composition and underlying disease. Length of PN (9.6 +/- 4.4 vs 19.5 +/- 10.5 days; p < 0.001) and presence of sepsis (21% vs 55%, p = 0.014) were the only variables associated with LD. It was not necessary to discontinue PN because of LD in any case.
Conclusions:
Early LD is present in more than 50% of our children on PN. In preventing LD we should try to avoid infection and to reduce the time on PN.