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Parenteral Nutrition-Associated Cholestasis Related to Parental Care

Peggy A. Wu , BS, John A. Kerner, MD^* and William E. Berquist, MD^*

^* Pediatric Gastroenterology, Hepatology and Nutrition, Lucille Packard Children's Hospital, Stanford University, Stanford, California

Correspondence: William Berquist, MD, 750 Welch Rd #116, Palo Alto, CA 94305. Electronic mail may be sent to berquist{at}stanford.edu.

Parenteral nutrition-associated cholestasis (PNAC) is a complication not uncommon in the pediatric population. In severe cases, patients require a liver transplant. To our knowledge, we report the only case of PNAC with end-stage liver failure in a child with short bowel syndrome that resolved with a change in caretaker. Until his care was transferred from his abusive parents, he was frequently admitted for infection and sepsis. His liver function vastly improved from aspartate aminotransferase (AST) 3139 units/L, conjugated bilirubin 25.9 mg/dL to AST 47 units/L, direct bilirubin 0.3 mg/dL under the care of his attentive foster mother, and a liver transplant was no longer necessary. Bacterial infection and sepsis are risk factors correlated with patients with PNAC requiring liver transplant. Prevention of infection by a good caregiver may be a means to reduce the incidence of PNAC.

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