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Parenteral nutrition-associated cholestasis related to parental care

Peggy A Wu1, John A Kerner, William E Berquist

  • 1Lucille Packard Children's Hospital, Stanford University, Stanford, California, USA.

Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition
|June 15, 2006
PubMed

Insights

Parenteral nutrition-associated cholestasis (PNAC) in a child with short bowel syndrome resolved with improved care. This case highlights the role of infection prevention in managing PNAC and potentially avoiding liver transplants.

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Neonatology

Background:

  • Parenteral nutrition-associated cholestasis (PNAC) is a serious complication in pediatric patients, sometimes necessitating liver transplantation.
  • Short bowel syndrome (SBS) increases the risk of PNAC due to prolonged reliance on parenteral nutrition.

Observation:

  • A pediatric patient with SBS developed end-stage liver failure attributed to PNAC.
  • The child experienced recurrent infections and sepsis under the care of abusive parents.

Findings:

  • A significant improvement in liver function was observed after the child was transferred to an attentive foster mother.
  • Liver enzymes (AST) and bilirubin levels dramatically decreased, resolving the need for a liver transplant.
  • Bacterial infection and sepsis were identified as key risk factors associated with PNAC and liver transplant requirements.

Implications:

  • This case suggests that meticulous infection control, facilitated by a dedicated caregiver, may be crucial in preventing severe PNAC.
  • Optimizing caregiving practices could potentially reduce the incidence of PNAC and the need for liver transplantation in vulnerable pediatric populations.
  • The findings underscore the link between environmental factors, infection, and liver health in children receiving parenteral nutrition.

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