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Necrotizing enterocolitis and total parenteral nutrition-associated cholestasis
R L Moss1, J B Das, J G Raffensperger
1Department of Surgery, University of New Mexico School of Medicine, Albuquerque 87131-5341, USA.
Nutrition (Burbank, Los Angeles County, Calif.)
|May 1, 1996
Summary
Necrotizing enterocolitis (NEC) can cause liver injury and cholestasis. Total parenteral nutrition (TPN) worsens this, leading to progressive liver damage specific to TPN-associated cholestasis (TPN-AC).
Area of Science:
- Pediatric Surgery
- Hepatology
- Neonatology
Background:
- Necrotizing enterocolitis (NEC) and total parenteral nutrition (TPN)-associated cholestasis (TPN-AC) are increasing in pediatric patients.
- The interaction between NEC and TPN-AC is not well understood.
Purpose of the Study:
- To investigate the impact of NEC and TPN on liver function and histology.
- To compare liver injury patterns in NEC patients with and without TPN.
Main Methods:
- Retrospective study of 24 surgical NEC patients, divided into NEC (n=7) and NEC + TPN (n=17) groups.
- Liver biopsies and serum/biliary bile acid level measurements were performed.
- Histological analysis and comparison of liver injury patterns between groups.
Main Results:
- Both NEC and NEC + TPN groups showed elevated serum bile acids and depressed biliary bile acids, indicating impaired bile acid transport.
- NEC patients exhibited biliary stasis and mild hepatocyte degeneration.
- NEC + TPN patients showed more advanced, TPN-AC-specific liver injury.
- Partial enteral feeding did not improve bile acid levels or halt histological injury progression.
Conclusions:
- NEC alone can cause functional cholestasis and liver injury.
- TPN exacerbates liver injury in NEC patients, causing specific progressive damage.
- NEC may increase liver susceptibility to TPN-induced injury.
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