INFECTION AND CHOLESTASIS IN NEONATES WITH INTESTINAL RESECTION AND LONG-TERM PARENTERAL-NUTRITION

Objectives: This retrospective study was conducted to determine the in cidence of cholestasis and liver failure in patients with intestinal r esection in the neonatal period who subsequently become dependent on p arenteral nutrition support and to assess the significance of associat ed clinical factors-gestational age, birth weight and length; length o f bowel resected; presence of ileocecal valve; enteral feeding history ; and infection-to the incidence and severity of cholestasis. Methods: Retrospective chart review of all patients in a single institution fr om May 1984 to February 1997 with neonatal small intestinal resection dependent on parenteral nutrition for at least 3 months. Results: Fort y-two patients fitting the inclusion criteria were the subjects of thi s review. Cholestasis developed in 28 (67%) while they were receiving parenteral nutrition (direct serum bilirubin mon than 2 mg/dl). In 21, the elevated direct bilirubin normalized while patients continued to receive parenteral nutrition. Seven patients progressed to liver failu re. In 14 patients, serum direct bilirubin never rose above 2 mg/dl. T he cholestatic patients did not differ from the noncholestatic in gest ational age, birth weight, and length; primary diagnosis; length of bo wel resected; or presence of ileocecal valve. The duration of dependen ce on parenteral nutrition was longer in noncholestatic (33.2 +/- 9 mo nths) than in cholestatic patients progressing to liver failure (19.4 +/- 3 months) or in cholestatic patients who recovered (16.1 +/- 1.9 m onths) (p < 0.05). Invasive fungal or bacterial infections occurred in all but one noncholestatic patient. The number of infections per pati ent was similar in all groups. The mean age (days) at first infection was significantly younger in cholestatic patients progressing to liver failure (28.5 +/- 5) and cholestatic patients who recovered (48.2 +/- : 14.2) than in noncholestatic patients (167 +/- 43.2) (p < 0.01). Inf ection preceded the onset of cholestasis in all but 3 patients by an a verage of 13.5 days. Infecting organisms and site of first infection w ere similar in all patients. Conclusions: Cholestasis is common in inf ants with neonatal intestinal resection. Liver failure develops in 16. 6%. Bacterial infection early in life characterized the cholestatic pa tients, and cholestasis developed shortly after the first infection in 90% of patients.