The frequency of parenteral nutrition-associated liver complications varies in studies from 7.4-84%. In follow-up studies, complications occurred in 40-60% of children who required long-term parenteral nutrition. Variation in reported frequency is due to differences in study populations (premature vs term infants or older children), definition of liver dysfunction (based on biochemical or histologic values), composition of parenteral nutrition solutions, duration of parenteral nutrition administration, and underlying medical or surgical conditions in study subjects.
In one study, approximately 30% of mostly premature infants had elevated liver enzyme concentrations after receiving parenteral nutrition for 2 weeks. Liver enzyme concentrations were elevated in 53% of children after 4 weeks of parenteral nutrition. Patients with short bowel syndrome who require a longer duration of parenteral nutrition have a higher frequency of liver complications.
Liver dysfunction occurred in 67% of children with short bowel syndrome who received parenteral nutrition for a mean duration of 16.5 weeks, compared with 30% of children with normal bowel length who received parenteral nutrition for a mean duration of 6 weeks. Liver dysfunction, mainly cholestasis, was reported in 65% of parenteral nutrition-dependent infants with short bowel syndrome.
The reported frequency of parenteral nutrition-associated cholestasis (PNAC) also varies among studies. In a retrospective review of medical records of neonates who received parenteral nutrition for at least 1 week, 15% of infants developed PNAC, (serum conjugated bilirubin concentrations >= 2 mg/dl).
In another study, the overall frequency of PNAC (serum conjugated bilirubin concentrations >= 2 mg/dl) was 43% in infants who received parenteral nutrition for 19-75 days (mean ? SEM 49.6 ? 7 days) and 67% in premature infants. The disorder occurred in 23% of premature infants (serum conjugated bilirubin concentrations >= 1.5 mg/dl) after a mean parenteral nutrition duration of 42 days.
Good nutrition can lead to an impressive range of benefits including improved survival, health, cognitive development, and work capacity. Conversely, undernutrition impairs the immunize response. As a result, poor nutrition increases the frequency, severity, duration and mortality of common childhood illnesses such as diarrhea, pneumonia, and measles. It also increases susceptibility to other infectious diseases such as malaria, tuberculosis and HIV/AIDS during complex emergencies.
