Low-Fat, High-Carbohydrate Parenteral Nutrition (PN) May Potentially Reverse Liver Disease in Long-Term PN-Dependent Infants

• Published in: Digestive diseases and sciences 2015-01, Vol.60 (1), p.252-259
• Main Authors: Jakobsen, Marianne Skytte, Jørgensen, Marianne Hørby, Husby, Steffen, Andersen, Leis, Jeppesen, Palle Bekker
• Format: Article
• Language: English
• Subjects: Bilirubin; Biochemistry; Child development; Enterocolitis, Necrotizing - drug therapy; Fat Emulsions, Intravenous - chemistry; Fatty Acids, Essential; Female; Gastroenterology; Hepatology; Humans; Infant; Infant, Premature; Infant, Premature, Diseases - therapy; Infants; Liver diseases; Liver Diseases - therapy; Male; Medicine; Medicine & Public Health; Monounsaturated fatty acids; Oncology; Original Article; Parenteral Nutrition - methods; Pneumoviridae; Retrospective Studies; Short Bowel Syndrome - surgery; Transplant Surgery
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-014-3317-x

Introduction Parenteral nutrition-associated cholestasis (PNAC) is a complication of long-term parenteral nutrition (PN). Removal of lipids may reverse PNAC but compromises the energy to ensure infant growth. The purpose of this study was to test whether a low-fat, high-carbohydrate PN regimen, which prevents and reverses PNAC in adults, could do the same in infants. This regimen could potentially avoid the problem of diminished energy input after removing nutritional lipids. Methods Infants developing PNAC over a 2-year period were started on a low-fat PN regimen with calories primarily from carbohydrates. The fat-free PN, containing 314 kJ/ml, was provided 5–6 times a week and fat, including essential fatty acids and fat-soluble vitamins, 1–2 times a week. Enteral feeding was continued according to individual tolerance. Results The study included 10 infants with short bowel syndrome (six with intestinal failure due to necrotizing enterocolitis, one with gastroschisis, one with complications due to unrecognized anal atresia and two with midgut volvulus). Median duration of PN with fat before initiating the low-fat regime was 69 days (25–75 % percentile: 41–75 days), and mean s-bilirubin was 139 µmol/l (range 87–323 µmol/l). Median duration with low-fat regimen was 69 days (25–75 % percentile: 18–123 days). Bilirubin reversed to normal (