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Hepatic secretory obstruction with total parenteral nutrition in the infant
Insights
Total parenteral nutrition can cause liver problems in infants, leading to cholestasis. Early detection using conjugated bilirubin and 5
Area of Science:
- Pediatric Gastroenterology
- Neonatal Medicine
- Hepatology
Background:
- Total parenteral nutrition (TPN) is crucial for infant nutrition but can lead to liver dysfunction.
- Cholestasis, characterized by impaired bile flow, is a known complication in infants receiving TPN.
Purpose of the Study:
- To investigate the incidence and early detection of transient hepatic secretory obstruction (cholestasis) in neonates and infants on TPN.
- To evaluate the sensitivity of specific biochemical markers for detecting cholestasis.
Main Methods:
- Prospective monitoring of conjugated bilirubin and 5' nucleotidase levels in infants receiving TPN.
- Comparison of marker sensitivity against serum alkaline phosphatase.
Main Results:
- Eight of 19 infants on TPN developed cholestasis, indicated by conjugated bilirubin > 2.0 mg/100 ml.
- Premature infants showed a higher incidence of cholestasis compared to full-term infants.
- 5' nucleotidase emerged as the most sensitive marker, detecting obstruction even with normal direct bilirubin levels.
Conclusions:
- TPN-associated cholestasis is a significant risk in neonates and infants, particularly premature ones.
- Early detection of cholestasis is achievable through regular monitoring of conjugated bilirubin and 5' nucleotidase.
- 5' nucleotidase is a highly sensitive indicator for TPN-induced hepatic secretory obstruction.
Abstract:
Transient hepatic secretory obstruction manifested primarily by chemical evidence of cholestasis with a conjugated bilirubin above 2.0 mg/100 ml occurred in eight of 19 neonates and infants receiving total parenteral nutrition. The incidence of cholestasis was greater in the premature than full-term infant. Prospective determinations of conjugated bilirubin and 5' nucleotidase are essential to detecting cholestasis before jaundice becomes obvious. These tests are more sensitive than serum alkaline phosphatase which normally rises after birth and during periods of accelerated osteoblastic activity. Preliminary data indicate that the 5' nucleotidase is the most sensitive indicator of secretory obstruction and may become elevated in patients with a normal direct bilirubin. The etiology of hepatic cholestasis during total parenteral nutrition is unknown but is presumed to be caused by interference with hepatocellular enzymes controlling bile secretion; immaturity of these enzyme systems increases the risk of secretory obstruction.