Early Central Catheter Infections May Contribute to Hepatic Fibrosis in Children Receiving Long-term Parenteral Nutrition

Hermans, Dominique*; Talbotec, Cécile; Lacaille, Florence; Goulet, Olivier; Ricour, Claude; Colomb, Virginie

Journal of Pediatric Gastroenterology & Nutrition: April 2007 - Volume 44 - Issue 4 - p 459–463
doi: 10.1097/MPG.0b013e318031a5c7
Original Articles: Hepatology & Nutrition

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.

*Department of Pediatrics, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

Pediatric Gastroenterology, Hepatology and Nutrition, Hôpital Necker-Enfants Malades, Paris, France

Received 12 December, 2005

Accepted 14 December, 2006

Address correspondence and reprint requests to Dominique Hermans, MD, Department of Paediatrics, Cliniques Universitaires St-Luc, 10, Avenue Hippocrate, B-1200 Brussels, Belgium (e-mail: dominique.hermans@clin.ucl.ac.be).

© 2007 Lippincott Williams & Wilkins, Inc.