Total parenteral nutrition (TPN) and gallbladder diseases in neonates. Sonographic assessment.
During a 1-year period, a prospective ultrasound (US) study of the biliary tract was performed in 41 neonates receiving total parenteral nutrition (TPN). Gallbladder sludge appeared in 18 neonates (44%) after a mean period of 10 days of TPN. The occurrence of this abnormality seems related to three main factors: prematurity with immaturity of the enterohepatic circulation of bile acids, duration of TPN, and lack of enteral nutrition. In five neonates (12%), an evolution of sludge to "sludge balls" was observed. Two neonates (5%) went on to develop uncomplicated gallstones and a spontaneous resolution occurred in one of them 6 months after the examination. This finding suggests conservative management in such cases. However, since cholecystitis or biliary tract obstruction are classical complications in older children, a US survey of neonates receiving TPN is useful to follow the abnormal gallbladder content, and rapid introduction of enteral feeding is advisable.
D002769:Cholelithiasis / Q000209:etiology; D004750:Enteral Nutrition; D005260:Female; D005704:Gallbladder / Q000473:pathology; D005705:Gallbladder Diseases / Q000175:diagnosis / Q000209:etiology*; D006500:Hepatic Duct, Common / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D013997:Time Factors; D014463:Ultrasonography