Journal List > Korean J Pediatr Gastroenterol Nutr > v.7(1) > 1110340

Korean J Pediatr Gastroenterol Nutr. 2004 Mar;7(1):61-73. Korean.
Published online Mar 31, 2004.
Copyright © 2004 The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition
Early Management of Total Parenteral Nutrition Induced Hepatic Dysfunction with Cyclic Parenteral Nutrition
Sung Soo Lee, Ju Young Chang, Hye Ran Yang, Jae Sung Ko, Kyung Hee Choi,* and Jeong Kee Seo
Department of Pediatrics, Seoul National University College of Medicine, Korea.
*Division of Pharmacy, Seoul National University Hospital, Seoul, Korea.


Liver function test abnormalities have been reported frequently in patients receiving total parenteral nutrition (TPN). In adults, it is known that liver complications decrease with the use of cyclic parenteral nutrition (CPN), especially if the shift to cycling was not too late. However, there are few studies about the effects of cycling on liver injury in children beyond the neonatal period. The aim of this study is to evaluate the effect of the early use of CPN on total parenteral nutrition induced hepatic dysfunction.


Twelve sets of CPN in 11 children (2 months to 17 years) were included in this study. Data on underlying diseases, age, length of time on TPN, macronutrient intake, complications, and biochemical parameters were collected from clinical records. All children had received CPN in the early period of persistent transaminase elevation or cholestasis complicated by previous continuous PN. The duration of infusion off-time in CPN was 2 hours in patients less than 3 months of age and 4 hours in the older children.


All 12 cases showed elevated aminotransferase and 5 of them also showed cholestasis. Serum total bilirubin concentration was normalized in all 5 cases with median periods of 8 days (p<0.05) after initiation of CPN. ALT either decreased significantly or was normalized in all cases with median periods of 30 days (p<0.05) on CPN. The CPN was well tolerated without significant complication except for one case of hyperglycemia.


The early use of cyclic parenteral nutrition had a beneficial effect in improving hepatic dysfunction complicated by TPN in children.

Keywords: Cyclic parenteral nutrition; Total parenteral nutrition; Cholestasis; Hepatic dysfunction