THE CORRELATION BETWEEN TOTAL PARENTERAL NUTRITION AND INCIDENCE OF NEONATAL CHOLESTASIS

Abstract

Introduction: Neonatal cholestasis (NC) is a diagnostic dilemma frequently countered in a neonatal care unit, affects approximately 1 in every 2500 infants. The most widely accepted hypothesis for the explanation of total parenteral nutrition associated cholestasis is that a lack of fat in the duodenum leads to stasis in the enterohepatic circulation, which then leads to the histological changes seen in the liver in this syndrome. Conjugated hyperbilirubinemia together with elevated serum bile acid levels is part of total parenteral nutrition associated cholestasis. Aim of work: We aimed in our work to find the correlation between receiving total parenteral nutrition and incidence of cholestasis Subjects and methodology: Our study was conducted on archieved records of 156 babies, selected from neonatal intensive care unit department in Ain Shams University Maternity Hospital between January 2017 and December 2017, babies of both gender, of gestational age ranging from 28-39 weeks, on total parenteral nutrition starting within the 1st week of life. We classified our cases into 2 groups according to their direct serum bilirubin level, into cholestatic group (n=36, 23.1%) with direct serum bilirubin higher than 20% of total serum bilirubin and non-cholestatic group (n=120, 71.9%) with direct serum bilirubin lower than 20% of total serum bilirubin through their illness according to Gupta et al., 2016. Results: Our results revealed that 36(23.1%) patients out of 156 patients developed cholestasis during their admission in NICU while on total parenteral nutrition. Prolonged duration of TPN, high doses of protiens, lipids had a highly statistically significant correlation with the incidence of parenteral nutrition associated cholestasis and outcome of patients. Conclusion: We found that there are highly significant correlation between prolonged duration of total parenteral nutrition, high doses of protients and lipids as main components of daily total parenteral nutrition and incidence of parenteral nutrition associated cholestasis . Significantly better outcome regarding resolution of cholestasis with early initiation of enteral feeding and usage of ursodeoxycholic acid during their course of treatment.