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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
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Year : 1999  |  Volume : 4  |  Issue : 3  |  Page : 123-127

Proposed management of hepatobiliary dysfunction in neonates receiving total parenteral nutrition, with particular reference to bile plug obstruction


Department of Pediatric Surgery All Institute of Medical Sciences New Delhi 110029, India

Correspondence Address:
D Misra
Department of Pediatric Surgery All Institute of Medical Sciences New Delhi 110029
India
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Source of Support: None, Conflict of Interest: None


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ABSTRACT: Objective: To review our experience in the management of neonates with TPN induced bile plug obstruction. Subjects: Although cholestatic jaundice is a known complication in infants on prolonged total parenteral nutrition(TPN), till recently no specific cause had been implicated. We treated two neonates who developed severe cholestasis following TPN therapy in the postoperative period. Result: In both neonates a Hippuran Imminodiacetic Acid(HIDA)scan showed absence of intestinal excretion at 24 hours. In one patient, laparotomy revealed Common Bile Duct(CBD) obstruction with a bile plug which was relieved by biliary irrigation. Icterus resolved postoperatively in 3 weeks. The second patient was not operated; death occurred at 9months of liver failure. Conclusions: We propose that biliary hyper viscidity may be a predominate factor causing hepatic dysfunction in some neonates on TPN therapy. In this paper we report a simple staging of hepatic dysfunction in post TPN cholestasis and suggest a stagewise management protocol with emphasis on preventive aspects. The treatment of bile plug obstruction in particular, has been discussed in detail.






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