Open AccessEarly Central Catheter Infections May Contribute to Hepatic Fibrosis in Children Receiving Long‐term Parenteral Nutrition
Author(s) -
Hermans Dominique,
Talbotec Cécile,
Lacaille Florence,
Goulet Olivier,
Ricour Claude,
Colomb Virginie
Publication year - 2007
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 131
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0b013e318031a5c7
Subject(s) - medicine , gastroenterology , cirrhosis , sepsis , cholestasis , parenteral nutrition , incidence (geometry) , complication , fibrosis , liver biopsy , hepatic fibrosis , surgery , group b , biopsy , physics , optics
Background: Bacterial infections in infants constitute a risk factor for parenteral nutrition (PN)–related cholestasis. The possible role of infections in the development of liver fibrosis, the most severe long‐term complication, has yet to be documented. This study retrospectively compares the incidence of sepsis in children with and without severe liver fibrosis. Patients and Methods: Medical reports of 30 children in prolonged PN programs between March 1985 and March 2000 were reviewed. Starting at birth, the mean PN duration was 65 months (range, 8–150 months). According to the results of liver biopsy (LB), patients were split into 2 groups: group A (n = 16) with severe liver fibrosis (ie, septal fibrosis involving >50% of portal fields or cirrhosis) and group B (n = 14) with normal hepatic architecture or mild fibrosis (<50% of portal fields). Results: Duration of PN at the time of LB was shorter in group A (30.5 months; range, 8–96 months) than in group B (105 months; range, 37–150 months; P < 0.001). In group A the incidence of sepsis was significantly higher than in group B (3.2 ± 0.3/year vs 1.5 ± 0.2/year) and the first infection occurred earlier (group A, 1 month [range, 1–2 months]; group B, 4 months [range, 1–19 months]). By contrast, both groups were similar in terms of pregnancy duration, birth weight, age of PN onset, underlying diseases, mode of PN delivery, and number of cholestasis episodes. Conclusions: Incidence and early onset of infections may contribute to the development of liver fibrosis in cases of long‐term PN. New strategies are required in prevention and treatment of infections in children receiving PN.