Yenidoğan Cerrahisi Servisinde Karşılaşılan Parenteral Beslenme ile İlişkili Karaciğer Hasarı
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Parenteral nutrition associated liver disease (PNALD) is an important issue concerns closely patients of pediatric surgery. The aim of this study is to determine the incidence of liver damage in parenteral nutrition (PN) receiving patients, precipitating factors for the development of PNALD and the effects of different PN preparations on the development of PNALD. The records of patients who received PN between Jan 2000 and May 2012 were evaluated restrospectively. PNALD was defined as plasma conjugated bilirubin levels greater than 2.0mg/dl. Surgical diagnosis, gender, body weight, gestational age, age at onset of PN, duration of PN, onset and duration of cholestasis, treatment of cholestasis, contents (lipid, protein and dextrose) and calory of PN, central catheter, sepsis and mortality of cases were noted. Patients were divided into two groups with respect to the preparation protocol of PN and the patients who developed cholestasis were compared with each other and control groups. A total of 166 patients who developed cholestasis in the period of January 2000 - May 2008 comprised Group 1a, and those in June 2008 - May 2012 comprised Group 2a. Control groups’ (Group 1b and Group 2b) patients were selected randomly. Longterm PN administration (42±24.6 day, p=0.02), presence of sepsis (p=0.04) and high dose lipid component in PN (3,5±0,7g/kg, p=0,01) were associated increased incidence of PNALD. When two different PN protocols were compared, especially low dose lipid containing preparations were found safe and PNALD was occured later (42±24.6 day, p=0.02). Commencement of enteral feeding was found to be the most effective treatment of cholestasis in our patients according to our results. In order to provide early diagnosis and prevention of PNALD, each patient receiving PN must be followed up closely.