PARENTERAL-NUTRITION ASSOCIATED CHOLESTASIS IN THE NEWBORN

Parenteral nutrition associated cholestasis in preterm infants and new born children is a frequent and serious disease with an incidence of 2 3% dependend on duration of parenteral nutrition and birthweight. The incidence of liver cirrhosis is 40% when parenteral nutrition is given 74-242 days. The pathogenesis remains unclear. Several predisposing f actors are discussed like immaturity, lack of hormonal stimulation by oral feeding, bacterial infection, liver toxicity of aminoacids and th eir products of photooxidation, lack of taurine, lack of antioxidation substances, hypermanganesaemia and pollution of infusion solutions. F urthermore sepsis during parenteral nutrition seems to multiply the ri sk of cholestasis. For prevention controlled studies recommend: 1. Ear ly enteral nutrition. 2. The reduction of parenteral aminoacids to les s than 3 g/kg/d. 3. Light protection for parenteral solutions. 4. Cycl ic infusion of parenteral nutrition. 5. The application of antibiotics (metronidazole, gentamicin) during parenteral nutrition. The most imp ortant therapeutic intervention is the beginning of oral feeding. Most of the time this leads to a decrease of icterus within two weeks. An icterus persisting longer than 3 weeks should be treated because of th e risk of liver cirrhosis. Further therapeutic interventions are: 1. C holezystokinin, good results in case studies which still has to be ver ified by a controlled study. 2. Ursodeoxycholic acid, its choleretic e ffectiveness is verified in several liver diseases by controlled studi es, but it is not proven in parenteral nutrition associated cholestasi s. 3. Laparoscopic biliary irrigation, successful in several case stud ies.