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Predicting liver failure in parenteral nutrition-dependent short bowel syndrome of infancy

Stuart S Kaufman1, Marieta Pehlivanova, Erin M Fennelly

  • 1Department of Pediatrics, Georgetown University School of Medicine, Institute of Transplantation, Georgetown University Hospital, Washington, DC 20007, USA. SSK27@gunet.georgetown.edu

The Journal of Pediatrics
|January 26, 2010
PubMed

Insights

Early blood test trends can predict liver failure (LF) in infants with parenteral nutrition-associated liver disease (PNALD). A total bilirubin level of 6 mg/dL by 3-6 months indicates a 36% LF risk, suggesting transplant referral.

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Neonatology

Background:

  • Parenteral nutrition-associated liver disease (PNALD) is a serious complication in infants with short bowel syndrome.
  • Early identification of infants at high risk for liver failure (LF) is crucial for timely intervention and potential transplant referral.

Purpose of the Study:

  • To determine if early trends in common blood tests can predict the risk of LF in infants with PNALD.
  • To establish criteria for liver transplant referral in this vulnerable population.

Main Methods:

  • Prospective study of 61 infants with PNALD, monitoring blood tests every 3 months.
  • Logistic regression analysis was used to identify independent predictors of LF.
  • Outcomes included death without transplant, LF with transplant, or liver recovery.

Main Results:

  • Total bilirubin, platelet count, and albumin levels were independent predictors of LF.
  • Infants with a total bilirubin of 6.0 mg/dL, platelet count of 220 x 10(3)/microL, and albumin of 3.5 g/dL at 3-6 months had a 36-38% predicted probability of LF.
  • Higher bilirubin and lower albumin levels correlated with increased LF risk.

Conclusions:

  • A total bilirubin level of 6 mg/dL between 3 to 6 months of age is a significant indicator for potential liver failure.
  • This threshold suggests that transplant referral is appropriate for infants with PNALD at this stage.
  • Early blood marker monitoring can aid in managing PNALD and guiding transplant decisions.
Abstract

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