Cholestatic jaundice as a complication associated with TPN

[Guest sageaugie]

How frequent is the incidence of cholestatic jaundice associated with TPN? In my own experience almost all babies, whom we had started on TPN, developed cholestatic jaundice.

[Dinesh N Patel]

I agree with you l have come across to cholestatic jaundice in ELBW Infants two times with TPN for _?more than 3wks with NEC. Both received intralipids and NBM for more than 15 days. Both improvement with time , treated with ursodiliol, vitamin suppliment(A D, E, K) and supportive care. We have rulled out other cause of cholestatic jaundice in newborn

[Guest sageaugie]

I have noticed cholestasis even with short term PN. Most of them resolved with initiation of enteral feeds. In your experience what has been the highest blirubin levels that you would have come across with TPN?

[Stefan Johansson]

Cholestatic jaundice is fairly common in my experience, among very preterm infants given TPN for shorter or longer periods of time.

Depending on the dynamics of the s-bili, we do nothing but follow s-bili over time until it resolves (which is should do if the diagnosis is correct).

If the s-bili is high or is increasing we medicate the baby with vitamin-K (0.1 mg/kg x1) , vitamin-E (7.5 mg/kgx2) and ursodeoxycholic acids (typically 10-15 mg/kg x 3), while following s-bili.

[Bmurbati]

the TPN related cholestasis is common in long term TPN, however it ca be delayed if the TPN used carefully,

it is unlikely to see cholestatic jaundice before 4-6weeks of starting TPN.

but if you are careful it can be delayed for 6 and even 12 months after initiating the TPN and this is few tips to decrease the risk like --

1- give cyclic TPN

2- alternative days lipids

3- protein not to exceeds 2.5g/kg/day

4- recurrent sepsis increase the risk of choestasis

4- start the treatment early as mentioned by Stefan Johansson

[Dinesh N Patel]

ThanksBmurbati for giving some tips for preventing cholastasis,.

I want to add

1-there are some study that Omegwin has prentive role for cholastasis if you cycle with intralipids.

2-Start trophic feeding as early possile as NBM for prolong period(>7days)is usualy associated with Cholastasis.

the highest s.bilirun level icame accross was 19 mg/dl in a pt with NEC With septisemia and NBM for 15 days.,recover complitely with supportive care and Ursioiol

[Guest sageaugie]

Thanks Bmurbati and Dinesh for sharing these tips

[Guest randa]

Thanks aloooooooooooooooooooooooot Bmurbati and Dinesh for sharing these usefull informations