Complications associated with total parenteral nutrition in infants with short bowel syndrome.

The use of total parenteral nutrition (TPN) in five out of six infants with short bowel syndrome (SBS) adaptation permitted enteral nutrition. The duration of TPN depended on the extent of the resection, whether it was proximal or distal, and the adaptation of the residual gut. Residual bowel measuring 10 cm required prolonged TPN in the sixth infant and was not compatible with survival. Catheter-related complications were infection, malposition and dislodgement of the catheter. Metabolic complications were easily controlled by regulating the concentration of the infusate and the rate of the infusion. Osteopenia was common in prolonged TPN and was corrected with vitamin D supplementation. Cholestasis was the most common complication. It was demonstrated with elevation of gamma-glutamyl-transpeptidase levels which became evident as early as six weeks after the introduction of TPN. Serum bilirubin and transaminase elevations were later manifestations. One infant died of hepatic decompensation. Late morphological manifestations were those of cholestatic changes with fibrosis. The biochemical abnormalities of cholestasis were reversible provided TPN was discontinued at an early stage.