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Utility of liver biopsy in the evaluation of pediatric total parenteral nutrition cholestasis

Buonpane, C. L.; Ares, G. J.; Englert, E. G.; Helenowski, I.; Cohran, V. C.; Hunter, C. J.

Am J Surg. 2018 Jul 26; 216(4):672-677

Abstract

BACKGROUND: Cholestasis is a serious complication of total parenteral nutrition (TPN) in neonates. Liver biopsies may be requested to assess the severity of cholestasis and fibrosis. We hypothesized that liver biopsy would not lead to changes in management or improved patient outcomes. METHODS: A single institution retrospective review of infants with TPN cholestasis from January 2008 to January 2016. OUTCOMES: length of stay, complications, change in management and mortality. Statistical analysis was performed using Fisher's exact test. RESULTS: Twenty-seven out of 95 patients with TPN cholestasis underwent liver biopsy. Liver biopsy was associated with increased utilization or ursodeoxycholic acid (p=0.001). There were no differences in length of stay (LOS) or mortality. One patient had a complication following anesthesia for liver biopsy, there were no bleeding complications recorded. CONCLUSIONS: Liver biopsy in patients with TPN cholestasis was associated with an increase in utilization of ursodeoxycholic acid. The effects of this are not fully understood; however, liver biopsy was not associated with improved patient outcomes such as LOS or mortality.

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