Role of lipid emulsions in cholestasis associated with long-term parenteral nutrition in children.
BACKGROUND
In children who depend on long-term parenteral nutrition (PN), liver disease is a major complication that may lead to end-stage liver failure requiring liver transplantation.


METHODS
This retrospective study investigated the influence of lipid emulsions on cholestasis onset in children receiving long-term total parenteral nutrition (TPN) with lipids. Ten children who presented with a total of 23 episodes of cholestasis, associated in 13 cases with thrombocytopenia, were studied.


RESULTS
Changes in the lipid delivery preceded these complications in more than half the cases. The temporary decrease in lipid administration led to normalization of bilirubin in 17 episodes.


CONCLUSIONS
These data suggest that lipid supply is one of the risk factors for PN-associated cholestasis. The link between cholestasis and the reticuloendothelial system overload needs to be better understood. Prevention of cholestasis might include the decrease in the lipid load. When cholestasis occurs, lipid supply should be temporarily stopped, especially in the case of associated thrombocytopenia.
Colomb
V
V
Gastroentérologie et Nutrition Pédiatriques, Hôpital Necker-Enfants Malades, Paris, France. virginie.colomb@nck.ap-hop-paris.fr
Jobert-Giraud
A
A
Lacaille
F
F
Goulet
O
O
Fournet
J C
JC
Ricour
C
C
D000293:Adolescent; D001663:Bilirubin / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002779:Cholestasis / Q000150:complications / Q000209:etiology* / Q000517:prevention & control; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D010976:Platelet Count; D012189:Retrospective Studies; D012307:Risk Factors; D013921:Thrombocytopenia / Q000150:complications / Q000517:prevention & control; D013997:Time Factors
D005217:Fat Emulsions, Intravenous; D001663:Bilirubin