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Total parenteral nutrition in infancy: effect on the liver and suggested pathogenesis

C A Hughes, I C Talbot, D A Ducker

    Gut
    |March 1, 1983
    PubMed

    Insights

    Prolonged parenteral nutrition in preterm infants can cause cholestasis, a liver condition, due to absent gut hormones. Liver cell damage may occur upon reintroducing enteral nutrition.

    Area of Science:

    • Neonatal Medicine
    • Pediatric Gastroenterology
    • Hepatology

    Background:

    • Prolonged parenteral nutrition (PN) is essential for preterm infants lacking gut function.
    • Jaundice is a potential complication in infants receiving long-term PN.
    • The exact mechanisms causing liver issues during PN are not fully understood.

    Purpose of the Study:

    • To investigate the cause of conjugated hyperbilirubinemia (jaundice) in preterm infants on prolonged PN.
    • To determine if PN directly causes liver injury or if other factors are involved.
    • To explore the impact of enteral nutrition resumption on liver health.

    Main Methods:

    • Biochemical analysis of liver function.
    • Histological examination of liver tissue.
    • Electron-microscopic evaluation of liver cells.
    • Investigation included seven jaundiced preterm infants receiving prolonged PN.

    Main Results:

    • Infants exhibited conjugated hyperbilirubinemia indicative of cholestasis without significant primary liver cell injury.
    • Findings suggest cholestasis results from suppressed gut-hormone production due to absent enteral nutrition.
    • Necropsy and animal studies support the hypothesis of suppressed trophic/secretory hormones.
    • Liver cell damage was suggested by biochemical and electron-microscopic findings upon resuming enteral nutrition.

    Conclusions:

    • Cholestasis in preterm infants on prolonged PN is likely due to absent enteral stimulation of gut hormones.
    • Direct toxic effects of PN on the liver appear unlikely.
    • Liver cell injury may be a consequence of reintroducing enteral nutrition after a period of absence.

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