Related Experiment Videos
Complications associated with total parenteral nutrition in infants with short bowel syndrome
S Nousia-Arvanitakis1, N Angelopoulou-Sakadami, K Metroliou
1Pediatric Department, Central General Hospital, Thessaloniki, Greece.
Insights
Total parenteral nutrition (TPN) enabled enteral nutrition in most infants with short bowel syndrome (SBS). However, residual bowel length critically impacts TPN duration and survival, with cholestasis being a frequent complication.
Area of Science:
- Pediatric Gastroenterology
- Neonatology
- Surgical Nutrition
Background:
- Short bowel syndrome (SBS) presents significant nutritional challenges in infants.
- Total parenteral nutrition (TPN) is a critical intervention for SBS management.
- Assessing TPN's role in SBS adaptation and associated complications is vital.
Purpose of the Study:
- To evaluate the efficacy of TPN in facilitating enteral nutrition adaptation in infants with SBS.
- To identify factors influencing TPN duration and outcomes in SBS.
- To characterize the complications associated with TPN in this population.
Main Methods:
- Retrospective analysis of six infants with SBS receiving TPN.
- Monitoring TPN duration, residual bowel length, and adaptation to enteral nutrition.
- Documentation of catheter-related, metabolic, and hepatic complications.
Main Results:
- TPN facilitated enteral nutrition in five of six infants.
- Residual bowel length (10 cm) was associated with prolonged TPN and non-survival in one case.
- Common complications included catheter issues, osteopenia, and cholestasis, with elevated GGT levels indicating early cholestasis.
Conclusions:
- TPN can enable enteral feeding in SBS, but outcomes depend on residual bowel length.
- Early detection and management of cholestasis are crucial for reversibility.
- Hepatic decompensation remains a risk in severe cases.
Abstract:
The use of total parenteral nutrition (TPN) in five out of six infants with short bowel syndrome (SBS) adaptation permitted enteral nutrition. The duration of TPN depended on the extent of the resection, whether it was proximal or distal, and the adaptation of the residual gut. Residual bowel measuring 10 cm required prolonged TPN in the sixth infant and was not compatible with survival. Catheter-related complications were infection, malposition and dislodgement of the catheter. Metabolic complications were easily controlled by regulating the concentration of the infusate and the rate of the infusion. Osteopenia was common in prolonged TPN and was corrected with vitamin D supplementation. Cholestasis was the most common complication. It was demonstrated with elevation of gamma-glutamyl-transpeptidase levels which became evident as early as six weeks after the introduction of TPN. Serum bilirubin and transaminase elevations were later manifestations. One infant died of hepatic decompensation. Late morphological manifestations were those of cholestatic changes with fibrosis. The biochemical abnormalities of cholestasis were reversible provided TPN was discontinued at an early stage.