Early Management of Total Parenteral Nutrition Induced Hepatic Dysfunction with Cyclic Parenteral Nutrition / 대한소아소화기영양학회지

PURPOSE: Liver function test abnormalities have been reported frequently in patients receiving total parenteral nutrition (TPN). In adults, it is known that liver complications decrease with the use of cyclic parenteral nutrition (CPN), especially if the shift to cycling was not too late. However, there are few studies about the effects of cycling on liver injury in children beyond the neonatal period. The aim of this study is to evaluate the effect of the early use of CPN on total parenteral nutrition induced hepatic dysfunction. METHODS: Twelve sets of CPN in 11 children (2 months to 17 years) were included in this study. Data on underlying diseases, age, length of time on TPN, macronutrient intake, complications, and biochemical parameters were collected from clinical records. All children had received CPN in the early period of persistent transaminase elevation or cholestasis complicated by previous continuous PN. The duration of infusion off-time in CPN was 2 hours in patients less than 3 months of age and 4 hours in the older children. RESULTS: All 12 cases showed elevated aminotransferase and 5 of them also showed cholestasis. Serum total bilirubin concentration was normalized in all 5 cases with median periods of 8 days (p<0.05) after initiation of CPN. ALT either decreased significantly or was normalized in all cases with median periods of 30 days (p<0.05) on CPN. The CPN was well tolerated without significant complication except for one case of hyperglycemia. CONCLUSION: The early use of cyclic parenteral nutrition had a beneficial effect in improving hepatic dysfunction complicated by TPN in children.

Clinical Effects of Cyclic Parenteral Nutrition on Total Parenteral Nutrition Induced Cholestasis in Infants

PURPOSE: This study was designed to assess the effects of cyclic parenteral nutrition(CP) on parenteral nutrition induced liver diseases. METHODS: Before and after CP, data were collected on diagnosis, age, duration of parenteral nutrition, macronutrients and biochemical parameters. Initially parenteral nutrition was cycled off for 1-2 hours and the off-time was advanced by 0.5-1 hour daily over 1 week. Blood and urine glucose were monitored during procedure. RESULTS: Data on 6 sets of CP in 4 patients, among whom 2 patients had undertaken CP 2 times, respectively, were analyzed. The mean age was approximately 4 months, ranging from 2 to 11 months. Underlying diseases were as follows : 2 cases of microvillous inclusion disease, 1 case of protracted diarrhea of infancy and 1 case of feeding intolerance. The mean duration of parenteral nutrition before CP were 38.6 days, and that of CP was 41.6 days. During CP, the mean total caloric intake of each patient was 107kcal/kg/day, and the mean weight gain was 6.0g/kg/day. After CP, the biochemical parameters changed as follows : bilirubin was decreased in 4 cases, not changed in 1 case but increased in 1 case who had sepsis during CP period; the level of ALT was decreased in 2 cases but increased in 2 cases and not changed in 2 cases. Overall, CP was tolerated well although 3 cases had hypoglycemia(serum glucose concentration less than 40mg/dL) at the initial CP period. CONCLUSION: CP has potential beneficial metabolic effects on total parenteral nutrition induced cholestasis with minimal complications.

Clinical Effects of Cyclic Parenteral Nutrition on Total Parenteral Nutrition Induced Cholestasis in Infants

PURPOSE: This study was designed to assess the effects of cyclic parenteral nutrition(CP) on parenteral nutrition induced liver diseases. METHODS: Before and after CP, data were collected on diagnosis, age, duration of parenteral nutrition, macronutrients and biochemical parameters. Initially parenteral nutrition was cycled off for 1-2 hours and the off-time was advanced by 0.5-1 hour daily over 1 week. Blood and urine glucose were monitored during procedure. RESULTS: Data on 6 sets of CP in 4 patients, among whom 2 patients had undertaken CP 2 times, respectively, were analyzed. The mean age was approximately 4 months, ranging from 2 to 11 months. Underlying diseases were as follows : 2 cases of microvillous inclusion disease, 1 case of protracted diarrhea of infancy and 1 case of feeding intolerance. The mean duration of parenteral nutrition before CP were 38.6 days, and that of CP was 41.6 days. During CP, the mean total caloric intake of each patient was 107kcal/kg/day, and the mean weight gain was 6.0g/kg/day. After CP, the biochemical parameters changed as follows : bilirubin was decreased in 4 cases, not changed in 1 case but increased in 1 case who had sepsis during CP period; the level of ALT was decreased in 2 cases but increased in 2 cases and not changed in 2 cases. Overall, CP was tolerated well although 3 cases had hypoglycemia(serum glucose concentration less than 40mg/dL) at the initial CP period. CONCLUSION: CP has potential beneficial metabolic effects on total parenteral nutrition induced cholestasis with minimal complications.