Hepatobiliary abnormalities and parenteral nutrition.

Area of Science:

• Hepatology
• Pediatric Gastroenterology
• Clinical Nutrition

Background:

• Parenteral nutrition-associated hepatobiliary dysfunctions (TPN-HBD) are significant causes of morbidity in newborns and infants.
• Cholestasis is a common TPN-HBD, linked to prematurity, low birth weight, and prolonged TPN duration.
• Pathogenesis is multifactorial, involving necrotizing enterocolitis, sepsis, and cardiac issues.

Purpose of the Study:

• To review the occurrence, pathogenesis, diagnosis, and management of TPN-HBD, focusing on cholestasis.
• To highlight the risk factors and histological findings associated with TPN-HBD.
• To discuss preventive strategies and therapeutic interventions for TPN-HBD.

Main Methods:

• Review of existing literature on TPN-HBD.
• Analysis of factors contributing to cholestasis and biliary complications.
• Evaluation of diagnostic criteria and histological features.
• Assessment of preventive and management strategies.

Main Results:

• TPN-HBD, particularly cholestasis, are more severe in younger infants and correlate with TPN duration.
• Risk factors include enteral starvation, defective bile acid transport, and hypercaloric TPN (especially glucose-only).
• Histological findings range from intralobular cholestasis to portal fibrosis and biliary cirrhosis.
• Biliary complications like acalculous cholecystitis and cholelithiasis are linked to bile stasis.
• Even minimal enteral feeding can prevent TPN-HBD.
• Choleretic agents show promise in prevention and management.

Conclusions:

• TPN-HBD, especially cholestasis, pose significant risks to neonates and infants, necessitating careful management.
• Enteral nutrition, even in small amounts, is crucial for preventing TPN-HBD.
• Choleretic agents offer a potential therapeutic avenue for managing TPN-induced liver issues.