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Parenteral nutrition associated cholestasis is a common complication of prolonged and exclusive parenteral nutrition. Ursodeoxycholic acid may be used to reduce the duration.

Infants subjected to major surgery are often unable to receive enteral nutrition for a long period of time, during which they require exclusive PN. After that, enteral nutrition is slowly introduced alongside with the reduction of the PN. In major surgery for congenital malformations of the digestive tract, additional risk factors for PNAC are the absence of enteral nutrition, intestinal bacterial translocation and sepsis.

Jejunal atresia and gastroschisis are independent risk factors for PNAC. In short bowel syndrome, changes in the bile acids enterohepatic cycle may also contribute to PNAC. Intravenous lipid emulsions used in PN may promote PNAC or protect against it depending on their composition.

A systematic review found lower bilirubin levels in children with intestinal failure and other conditions receiving parenteral n-3 ILE compared with n-6 ILE. However, it was concluded that current data is insufficient to support the use of parenteral n-3 ILE in children, suggesting further trials examining long-term clinical outcomes and harms.

The further availability of SMOFlipid led the investigators to compare the effect of both ILE on the liver tests associated with PNAC of neonates subjected to corrective surgery for major congenital abnormalities, since to the best of our knowledge no prospective study has made this comparison specifically in this population.

Parenteral nutrition protocol based on the National Consensus for Neonatal PN. Whenever possible PN with ILE is initiated within the first 24 hours after birth.

Preventive Effect Of Ursodeoxycholic Acid On Parenteral Nutrition

Associated cholestasis is well recognized phenomenon in the term and preterm infant receiving long-term parenteral nutrition.

The aim of this study was to evaluate the effect of ursodeoxycholic acid use on cholestasis in newborns on prolonged TPN.

Methods: A total of 56 infants were enrolled in this retrospective study: control group consisted of lower birth weight infants, as well as the group of pediatric and surgical patients treated with UDCA. Blood chemistries were obtained two times weekly.

All of 56 newborns developed cholestasis but duration of parenteral nutrition before onset of cholestasis was significantly longer in Ursodeoxycholic Acid treated patients. Average duration of PN before the onset of cholestasis in control group of patients was 25 days in distinction from treated pediatric and surgical patients.

Parenteral Nutrition-Associated Cholestasis And Triglyceridemia

This is the largest trial comparing the effects of two intravenous lipid emulsions in term and near-term infants. We studied the effects of two intravenous lipid emulsions composed with either 30% soybean oil, 30% medium-chain triglycerides, 25% olive oil, and 15% fish oil or with 50% MCT and 50% soybean oil n-6 on the incidence of cholestasis in surgical term and near-term neonates.

Fish oil containing intravenous lipid emulsions in parenteral nutrition-associated cholestatic liver disease. Impact of new generation lipid emulsions on cellular mechanisms of parenteral nutrition-associated liver disease.

Alternative lipid emulsions versus pure soy oil based lipid emulsions for parenterally fed preterm infants. Comparison of liver function with two new/mixed intravenous lipid emulsions in children with intestinal failure.

There was no significant difference among treated pediatric and surgical patients and between lower and higher birth weight infants considering the CB, ALT, AST and AP peak.

Duration of cholestasis was significantly decreased in all treated groups. Cholestasis developed significantly later in treated groups than in the controls.