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[Hepatobiliary changes during exclusive parenteral feeding in infants with severe diarrhea]
M Larchet1, G Duhamel, D Pariente
1l'Unité de Réanimation digestive et d'Assistance nutritive, Hôpital Necker-Enfants Malades, Paris.
Insights
Preventing hepatic changes during prolonged total parenteral nutrition (TPN) in infants is crucial. Oral metronidazole or human milk showed promise in preventing TPN-induced liver issues.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Nutritional Support
Background:
- Hepatic changes are a concern during prolonged total parenteral nutrition (TPN) in infants.
- Identifying factors and preventive treatments for TPN-induced liver complications is essential.
Purpose of the Study:
- To investigate factors contributing to hepatic changes during TPN.
- To evaluate the efficacy of oral metronidazole and human milk as preventive treatments for TPN-associated liver issues in infants.
Main Methods:
- A prospective study involving 30 infants with severe protracted diarrhea, divided into four groups: control, human milk, metronidazole, and parenteral antibiotics.
- Sequential monitoring included liver function tests, serum and bile acids, duodenal flora, ultrasonography, and liver histology in some cases.
Main Results:
- All groups showed liver function changes by day 15 of TPN.
- Infants receiving metronidazole or human milk demonstrated improvement, while the control group worsened (p<0.02).
- The control group exhibited increased chenodeoxycholic acid levels (p<0.01) without changes in lithocholic acid.
Conclusions:
- Oral metronidazole and human milk may prevent hepatic complications associated with prolonged TPN in infants.
- These findings support the preventive administration of metronidazole or human milk during extended TPN regimens.
Abstract:
In order to specify the factors responsible for the hepatic changes occurring during total parenteral nutrition (TPN) and to propose a preventive treatment, 30 infants treated for severe protracted diarrhea were prospectively distributed into 4 groups: I (n = 10): controls; II (n = 7): oral administration of human milk since the 15th day of TPN; III (n = 5): oral metronidazole since the 15th day; IV (n = 8): parenteral antibiotic therapy for septicemia since the 1st day. Contrary to group IV, the first 3 groups were randomly constituted on the 15th day. Liver function tests, bile and serum biliary acids, duodenal flora, hepato-biliary ultrasonography and, in 12 cases, liver histology were sequentially studied. Liver function changes were observed on the 15th day in all groups. An improvement occurred 15 days later in the infants treated, when the control group worsened (p less than 0.02). A significant increase of bile chenodeoxycholic acid levels was observed in the control group only (p less than 0.01), without change in lithocholic acid levels. These results lead the authors to recommend the preventive use of metronidazole or human milk during prolonged TPN in infants.