Atlas of Neonatal Pathology: Total parenteral nutrition associated hepatic damage

+ Introduction

+ Support

+ Neonatal pathology

Total parenteral nutrition associated hepatic damage

Introduction

Disturbance of liver function and cholestatic jaundice are well recognized complications of prolonged paranteral nutrition. The TPN-associated cholestasis is related to the duration of treatment and correlated inversely with the gestational age and birth weight.

Etiology

hepatic damage due to amino acid component of intravenous nutrition (hepatotoxic damage)
lack of oral feeding

Macroscopic appearance

Dark green liver.

Pictures

Hepatic damage with prolonged total parenteral nutrition in premature infant born at 25 week's gestation with birth weight 800g. The baby underwent an operation for necrotizing enterocolitis for the first time at the age of 10 days. The baby died from complications of NEC at 33 days of age. Note the icteric skin and dark green liver. Intrahepatic cholestasis, Macro, autopsy (73831) Intrahepatic cholestasis, Macro, autopsy (73832)

Histology

cholestasis (bile within hepatocytes and canaliculi) is the earliest morphologic alteration
prolonged therapy is associated with portal fibrosis, bile ducts proliferation and mild portal inflammatory reaction
progression to hepatic fibrosis is possible