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Hyperalimentation associated hepatotoxicity in the newborn.
1Division of Neonatal-Perinatal Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104.
Annals of Clinical and Laboratory Science
|March 1, 1992
Summary
Total parenteral nutrition (TPN) can cause liver damage, specifically bile cholestasis, in premature infants. Early introduction of enteral nutrition can prevent or reverse this TPN-associated liver injury.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Total parenteral nutrition (TPN) is crucial for premature infants with pulmonary issues.
- TPN, or hyperalimentation, carries risks, notably liver toxicity.
Purpose of the Study:
- To examine the complications and limitations of TPN in neonates.
- To investigate the etiology and progression of TPN-associated liver injury.
Main Methods:
- Review of pathological lesions in TPN-exposed neonates.
- Analysis of factors contributing to TPN-cholestasis, including nutritional components and deficiencies.
Main Results:
- Bile cholestasis is the primary lesion, likely multifactorial.
- Amino acid solutions, high calorie-to-nitrogen ratios, and nutrient deficiencies are implicated.
- TPN-cholestasis can lead to fibrosis and cirrhosis in prolonged cases.
Conclusions:
- Premature infants under 1500g receiving TPN for over two weeks are most vulnerable.
- Even minimal enteral nutrition (10% of intake) is beneficial.
- Recovery is likely once enteral feedings are established, mitigating TPN-induced liver disease.