Wendel Danielle, Mortensen Melissa, Harmeson Alisha, Shaffer Michele L, Hsu Evelyn, Horslen Simon
Seattle Children's Hospital.
University of Washington School of Medicine, Seattle, WA.
J Pediatr Gastroenterol Nutr. 2018 Feb;66(2):212-217. doi: 10.1097/MPG.0000000000001798.
Malnutrition is a common complication of end-stage liver disease (ESLD) associated with poor liver transplant outcomes. Nasogastric feeds are used for nutritional supplementation, but some patients remain malnourished. Parenteral nutrition (PN) can be effective, but has potential complications. The primary objective was to evaluate the effect of PN on anthropometric measures in children with ESLD awaiting liver transplant. Secondary objectives were evaluation of PN-associated complications, liver function tests, pediatric end-stage liver disease scores, waitlist time, and post-transplant length of stay (total and time in the intensive care unit).
A single-center, retrospective chart review analyzing pediatric patients with ESLD receiving PN who were transplanted during a 6-year period. Data were trended and described over time, as were the relationships between anthropometric data and time receiving PN.
A total of 44 patients with ESLD were transplanted between January 2010 and December 2015. Eighteen (41%) received PN before transplant; all had biliary atresia with median age at transplant of 10 months (range, 5-18 months). Mid-upper arm circumference and triceps skinfold thickness showed resolution of malnutrition in 7 patients (39%) with normalization of 1 measure in another 4 patients (22%). Of the remaining, 6 had improved z scores and 1 had worsening malnutrition. No deaths occurred in patients receiving PN. Central line infection rates were 3.8/1000 catheter days with 8 total infections in 6 patients over a total of 2117 catheter days.
Children with ESLD and malnutrition who have failed enteral feeding may benefit from PN to improve and/or resolve malnutrition before liver transplant.
营养不良是终末期肝病（ESLD）的常见并发症，与肝移植预后不良相关。鼻胃管喂养用于营养补充，但一些患者仍存在营养不良。肠外营养（PN）可能有效，但有潜在并发症。主要目的是评估PN对等待肝移植的ESLD儿童人体测量指标的影响。次要目的是评估PN相关并发症、肝功能检查、儿童终末期肝病评分、等待名单时间以及移植后住院时间（总计及在重症监护病房的时间）。
一项单中心回顾性图表审查，分析6年内接受PN并接受移植的ESLD儿科患者。数据随时间变化进行趋势分析和描述，人体测量数据与接受PN的时间之间的关系也进行了分析。
2010年1月至2015年12月期间，共有44例ESLD患者接受了移植。18例（41%）在移植前接受了PN；所有患者均患有胆道闭锁，移植时的中位年龄为10个月（范围5 - 18个月）。上臂中部周长和三头肌皮褶厚度显示，7例患者（39%）的营养不良得到改善，另外4例患者（22%）的一项指标恢复正常。其余患者中，6例的z评分有所改善，1例的营养不良情况恶化。接受PN的患者无死亡病例。中心静脉导管感染率为3.8/1000导管日，在总共2117个导管日中，6例患者共发生8次感染。
肠内喂养失败的ESLD和营养不良儿童可能从PN中获益，以在肝移植前改善和/或解决营养不良问题。
