91 TOTAL PARENTERAL NUTRITION ASSOCIATED PHOSPHOLIPIDOSIS OF THE LIVER IN INFANTS

Abstract

A variety of histologic aspects have been reported to occur during the course of parenteral nutrition(PN)in pediatrics as well as in adults patients. Phospholipidosis has been described with drugs administration. After a month of TPN we studied liver histology in 7 infants ranged from 2 to 8 months. All were without any previous liver disease and presented protracted diarrhea requiring bowel rest. PN Provided daily nitrogen(602±37mg/kg)and no protein energy(369±51KJ/kg) intakes, without intravenous fat emulsion during the first month. In addition to repeated liver function tests, we performed percutaneous liver biopsy after 30 PN days, using Hepafix needle(1,4mm). Liver specimens were fixed in buffered formalin and stained using lipids histochemistry:oil red O,Nils blue, Holczinger, Adams and Baker OTAN. Results indicated hepatocytes and macrophages phospholipidis deposits in 5 patients. Other abnormalities were observed including:portal and periportal fibrosis(5/7)bile ductular proliferation(6/7), severe portal and periportal inflammation(6/7)with mild necrosis in 2 patients; steatosis affecting less than 20% of hepatic parenchymal (2/7). Histologic cholestasis was not observed. Beside well known liver abnormalities, hepatic phospholipidosis is first described during TPN in infants. The mechanism of this phospholipids accumulation is unknown. It could be due to the alteration of phospholipids metabolism and/or to the interaction with TPN solution components even in the absence of fat emulsion administration.