ARE CARDIAC INFANTS ON PARENTERAL NUTRITION AT GREATER RISK OF INTESTINAL-FAILURE ASSOCIATED LIVER-DISEASE?.

Brooks, T.; Rhodes, A.

ARE CARDIAC INFANTS ON PARENTERAL NUTRITION AT GREATER RISK OF INTESTINAL-FAILURE ASSOCIATED LIVER-DISEASE?.

All Authors

Brooks, T.

Rhodes, A.

LTHT Author

Brooks, Teresa
Rhodes, Alix

LTHT Department

Medicines Management & Pharmacy Services
Clinical Pharmacy
Leeds Children's Hospital
Children's Services
Paediatric Dietetics

Non Medic

Pharmacist
Children's Dietitian

Publication Date

2025

Item Type

Conference Abstract

Abstract

Aim The aim was to see if there was a specific association with intestinal failure associated liver disease (IFALD) in infants with congenital heart disease (CHD) whilst on parenteral nutrition (PN). Parenteral nutrition is commonly provided to infants with CHD due to feeding delays associated with clinical status. IFALD is well-documented with liver cholestasis affecting up to 15.7% of all infants with short-term PN (<=1 month), 60.9% in long-term PN (>=2 months).1 CHD can be associated with liver dysfunction2 which could hinder hepatocytes from secreting bile, resulting in cholestasis. The aim was to see if there was a specific association with IFALD in infants with CHD whilst on PN. Method A retrospective review was conducted looking at patients less than 1 year of age with CHD on PN for greater than 14 days between 2017-2023. The enteral feeding status was noted and baseline and peak bilirubin levels, with percentage of conjugated bilirubin were reviewed. Results 46 episodes of PN were included in the data collection. 59% of PN were in the neonatal period (<=28 days), of this 96% had a bilirubin peak within 14 days of PN, these were not deemed as IFALD, but likely neonatal jaundice. 4% (n=1) had a bilirubin peak at day 35 of PN and high percentage conjugated bilirubin, reflecting a case of cholestasis. 41% of PN episodes were in infants (>28 days). In this cohort 84% had no rise in bilirubin against baseline or remained in reference range. 16% (n=3) had a bilirubin peak after 14 days, 2 patients had no conjugated bilirubin screen, whilst one had a high percentage of conjugated bilirubin. In 82% of episodes enteral feeds were started within 14 days of starting PN. Conclusion There was a high frequency of possible neonatal jaundice in the cohort making definite conclusions hard to determine. Discounting these cases, only 4% of PN episodes lasting >14 days developed elevated total bilirubin and/or high percentage of conjugated bilirubin suggesting a possible link to IFALD. Compared to the frequency of PN cholestasis in the literature (15.7-60.9%1 this is low, suggesting CHD may not be associated with a greater risk of IFALD. Additional consideration needs to be given to protective factors in place impacting on results seen. Over the past 5 years lipid emulsion within the Leeds Children's Hospital have change to primarily SMOFlipid 20% or ClinOleic, which is known to decrease plasma bilirubin levels,3 therefore reducing patients meeting the threshold for cholestasis diagnosis. Also, the majority of patients were commenced on enteral feeds within the first 14 days of PN, which is known to stimulate the entero-biliary axis and protect against IFALD.4.