Publication: Impacto del ciclado de la nutrición parenteral prolongada en recién nacidos
Loading...
Files
Official URL
Full text at PDC
Publication Date
2017-01-26
Authors
Advisors (or tutors)
Editors
Journal Title
Journal ISSN
Volume Title
Publisher
Universidad Complutense de Madrid
Citations
Exportar
Abstract
La nutrición parenteral (NP) es un tratamiento fundamental que ha disminuido la morbimortalidad en aquellos pacientes que no son capaces de recibir alimentación enteral o en los casos con función gastrointestinal inadecuada. Las complicaciones hepatobiliares más frecuentes asociadas a su uso son la esteatosis en adultos, la colestasis en pacientes pediátricos, y la producción de barro biliar en ambos. La colestasis asociada a nutrición parenteral prolongada (CANNP) se define como aumento de bilirrubina directa (BD) por encima de 1,5-2 mg/dL, y/o o más del 50% de la bilirrubina total (BT), en aquellos pacientes que precisan NP más de 14 días consecutivos. Al realizar biopsia hepática se han descrito evolutivamente colestasis intracelular y canalicular tras 2 semanas de NP, que es el hallazgo anatomopatológico más común, proliferación de los canalículos biliares, fibrosis de los tractos portales y cirrosis, si la NP se prolonga más de 12 semanas. La mortalidad asociada está entre el 11 y el 30%, aumentando en el grupo de pacientes en los que la colestasis no se resuelve, y en aquellos que no alcanzan una nutrición enteral (NE) exclusiva. Las causas más frecuentes de mortalidad son la sepsis, tanto de origen intestinal como la asociada a catéter (SAC); y el fallo hepático progresivo relacionado con la dependencia de nutrición parenteral prolongada (NPP). La incidencia de CANPP es muy variable en la literatura y va desde el 7 al 80%, según las características de los pacientes incluidos en el estudio y los parámetros bioquímicos con los que se defina la colestasis. En RN ha disminuido desde un 60% en la década de los setenta, hasta un 30% en los noventa. Sin embargo, si hablamos de RN con fallo intestinal, muchos de ellos con diagnóstico de síndrome de intestino corto (SIC), la cifra asciende hasta el 65-80%. Aunque su fisiopatología exacta sigue siendo desconocida, se han propuesto como factores implicados fundamentales la composición de la NP por aporte excesivo de proteínas y lípidos; y la falta de suplementación con taurina, la traslocación bacteriana a través de la pared intestinal debido al sobrecrecimiento intestinal, y la inmadurez del sistema excretor biliar que encontramos en recién nacidos pretérmino (RNPT)...
Total parenteral nutrition (PN) is a fundamental treatment that has decreased morbidity and mortality in those patients who are not able to receive enteral feeding or in cases with inadequate gastrointestinal function. It is often associated to hepatobiliary complications been the most frequent of them intrahepatic cholestasis in newborns and infants, steatosis in adults and biliary sludge in both. Parenteral nutrition-associated cholestasis (PNAC) is defined as increased direct bilirubin (DB) over 1.5-2 mg/dL and/or more than 50% of total bilirubin (TB) in patients requiring PN more than 14 consecutive days. In reviews in which liver biopsy has been performed, it is described after two weeks of PN, a universal finding, intracellular and intracanalicular cholestasis, after 4 weeks of PN bile duct proliferation, portal fibrosis after 8- 12 weeks of NP and frank biliary cirrhosis if PN extends over three months. The associated mortality is between 11 and 30%, increased in patients with unsolved cholestasis and in those who do not reach the exclusive enteral nutrition (EN). The most usual causes from mortality are catheter related sepsis (CRS) and progressive liver failure developed in relation to the dependence of prolonged parenteral nutrition (PPN). The incidence of PNAC was reported to be from 7 to 80%, depending on the characteristics of the patients included in the study and the biochemical parameters that define cholestasis. The incidence in newborns has decreased from 60% in the seventies to 30% in the nineties. In PN dependent infants with intestinal failure, many of whom have short bowel syndrome (SBS) the incidence increases to 65-80%. Although the pathogenesis of PNAC is not well understood, many factors have been associated with the development of PNAC, the composition of the PN by excessive intake of proteins and lipids, and lack of taurine supplementation, small intestinal bacterial overgrowth (SIBO), frequent in patients with diagnosis of SBS, and the immaturity of bile excretory system in preterm infant. The main factors involved in the multifactorial etiology of PNAC are the longer duration of the PN, prematurity and sepsis episodes...
Total parenteral nutrition (PN) is a fundamental treatment that has decreased morbidity and mortality in those patients who are not able to receive enteral feeding or in cases with inadequate gastrointestinal function. It is often associated to hepatobiliary complications been the most frequent of them intrahepatic cholestasis in newborns and infants, steatosis in adults and biliary sludge in both. Parenteral nutrition-associated cholestasis (PNAC) is defined as increased direct bilirubin (DB) over 1.5-2 mg/dL and/or more than 50% of total bilirubin (TB) in patients requiring PN more than 14 consecutive days. In reviews in which liver biopsy has been performed, it is described after two weeks of PN, a universal finding, intracellular and intracanalicular cholestasis, after 4 weeks of PN bile duct proliferation, portal fibrosis after 8- 12 weeks of NP and frank biliary cirrhosis if PN extends over three months. The associated mortality is between 11 and 30%, increased in patients with unsolved cholestasis and in those who do not reach the exclusive enteral nutrition (EN). The most usual causes from mortality are catheter related sepsis (CRS) and progressive liver failure developed in relation to the dependence of prolonged parenteral nutrition (PPN). The incidence of PNAC was reported to be from 7 to 80%, depending on the characteristics of the patients included in the study and the biochemical parameters that define cholestasis. The incidence in newborns has decreased from 60% in the seventies to 30% in the nineties. In PN dependent infants with intestinal failure, many of whom have short bowel syndrome (SBS) the incidence increases to 65-80%. Although the pathogenesis of PNAC is not well understood, many factors have been associated with the development of PNAC, the composition of the PN by excessive intake of proteins and lipids, and lack of taurine supplementation, small intestinal bacterial overgrowth (SIBO), frequent in patients with diagnosis of SBS, and the immaturity of bile excretory system in preterm infant. The main factors involved in the multifactorial etiology of PNAC are the longer duration of the PN, prematurity and sepsis episodes...
Description
Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Pediatría, leída el 10/02/2016