Objectives: Parenteral nutrition (PN)is an important therapeutic modality for neonates with specialised situation. But PN induced cholestasis is a serious problem. To find out incidence, clinical and investigational profile and therapeutic modality in neonates the following study was done.

Method: Fifty neonates who were admitted in pediatric gastroenterology ward of PGIMER Chandigarh from July 1993 to June 2003 and developed PN induced cholestasis were enrolled for the study. Detailed clinical history, incidence of PN induced cholestasis, age, sex, gender of babies, IUGR status, duration of PN, types of PN fluid , LFT, biochemical profile like glucose, electrolyte , urea, creatinine, PTI etc. have been noted. Amino acid /dextrose/lipid emulsion solution/trace element etc. were given. Analysis of ABG/Hb%/glucose electrolytes/platelet/LFT/RFT/USG whole abdomen etc. were routinely done and correction was given accordingly. Enteral feeding with expressed breast milk was started on all cases.

Results: Out of 50 infants who received PN 30(60%) developed cholestasis. Male was 20 and female was 10. Premature babies (less than 37 weeks) was 35(70%), SGA was 20(40%), duration of PN was more than 2 weeks in 45(90%) cases. Surgical neonates (short gut syndrome following NEC, intestinal atresia, Hirsprung, gastroschisis etc). were 5(10%). Out of 30 neonates- all developed rise of SGOT/SGPT, bilirubin. USG of 30 cholestatic babies shows hepatomegaly. Features of portal hypertension (e.g ascites, splenomegaly, GI bleed  etc. were not seen in any case). PN was stopped temporarily when choestasis developed. Enteral feeding with expressed breast milk was gradually increased. UDCA was given at a dose of 15mg/kg/day in two divided doses and antibiotics were given when indicated. Metabolic complication (e.g hypoglycemia, hyperglycemia, hypertriglyceridemia/ sepsis etc. were taken care of.

Conclusion: PN induced cholestasis is a serious problem in neonate. Prematurity/SGA baby/male baby/high carbohydrate/lack of eternal feeding is risk factors. Maximally tolerated enteral nutrition/cyclic parenteral nutrition/ omegaven/ avoiding high carbohydrate solution are protective against PN induced cholestasis.

Keyword: Neonatal Parenteral nutrition, cholestasis.

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Sujay Chaudhuri

Division of Pediatric Gastroenterology, Department of Gastroenterology, PGIMER Chandigarh

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