Related Experiment Video
Updated: May 26, 2026
Effect of Hyaluronic Acid 35 kDa on an In Vitro Model of Preterm Small Intestinal Injury and Healing Using Enteroid-Derived Monolayers
Published on: July 28, 2022
Parenteral plant sterols and intestinal failure-associated liver disease in neonates
Annika Kurvinen1, Markku J Nissinen, Sture Andersson
1Section of Pediatric Surgery, Children's Hospital, University of Helsinki, Helsinki, Finland. annika.kurvinen@helsinki.fi
Insights
Neonatal intestinal failure-associated liver disease (IFALD) is more common and linked to prolonged parenteral nutrition (PN) and elevated plant sterols (PS). High PS levels, particularly stigmasterol, may contribute to IFALD in neonates.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Neonatal Nutrition
Background:
- Intestinal failure-associated liver disease (IFALD) is a serious complication in patients receiving parenteral nutrition (PN).
- Neonates are particularly vulnerable to IFALD due to immature organ systems and prolonged PN dependence.
- The role of parenteral plant sterols (PS) in the pathogenesis of IFALD is not fully understood.
Purpose of the Study:
- To evaluate the incidence of prolonged PN, IFALD, and associated complications in neonates compared to children.
- To investigate the significance of parenteral plant sterols (PS) in neonatal IFALD.
- To compare serum sterol profiles and liver biochemistry between neonates and children with IFALD and healthy controls.
Main Methods:
- Prospective study of 28 neonates and 11 children with intestinal failure requiring PN.
- Repeated measurements of serum cholesterol, noncholesterol sterols (including PS), cholestanol, cholesterol precursors, and liver biochemistry.
- Comparison with healthy neonate and child control groups.
Main Results:
- IFALD occurred significantly more frequently in neonates (63%) than children (27%).
- Neonates exhibited markedly elevated serum PS (2- to 22-fold) and cholestanol compared to controls and children on PN.
- Higher serum PS and cholestanol levels correlated with IFALD presence and PN duration; IFALD persisted in 25% of neonates post-PN.
Conclusions:
- Neonates on PN have a higher incidence of IFALD, associated with PN duration and significantly increased serum PS, especially stigmasterol.
- Accumulation of parenteral plant sterols appears to be a key factor contributing to IFALD in neonates.
- These findings highlight the need for monitoring PS levels in neonates receiving prolonged PN.
Objectives:
We prospectively evaluated incidence of prolonged (>28 days) parenteral nutrition (PN), associated complications, and significance of parenteral plant sterols (PS) in neonatal intestinal failure-associated liver disease (IFALD) compared with children.
Methods:
We recruited 28 neonates (mean age 50 days, range 28-126) and 11 children (6.9 y, 2.1-16.6) in all of Finland. Patients underwent repeated measurements of serum cholesterol, noncholesterol sterols, including PS, cholestanol and cholesterol precursors, and liver biochemistry during and 1 month after discontinuation of PN. Healthy matched neonates (n=10) and children (n=22) served as controls.
Results:
IFALD occurred more frequently among neonates (63%) than children (27%; P<0.05). Ratios of serum PS, including stigmasterol, sitosterol, avenasterol, and campesterol, and total PS were increased among neonates compared with healthy controls and children on PN by 2- to 22- and 2- to 5-fold (P<0.005), respectively. Neonates with IFALD had significantly higher ratios of serum PS and cholestanol compared with neonates without IFALD (P<0.05). Total duration of PN associated with serum cholestanol, stigmasterol, avenasterol, alanine aminotransferase, and aspartate aminotransferase (r=0.472-0.636, P<0.05). Cholestanol and individual serum PS, excluding campesterol, reflected direct bilirubin (r=0.529-0.688, P<0.05). IFALD persisted after discontinuation of PN in 25% of neonates with 4.2- and 2.2-times higher ratios of serum stigmasterol and cholestanol compared with neonates without IFALD (P<0.05).
Conclusions:
Frequent occurrence of IFALD among neonates on PN displays an association to duration of PN and markedly increased serum PS, especially stigmasterol, in comparison to healthy neonates and children on PN. Striking accumulation of parenteral PS may contribute to IFALD among neonates.
Related Concept Videos
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...