PN-Associated Liver Disease (PNALD)

PNALD is also called

IFALD

PNALD

Parenteral Nutrition-Associated Liver Disease

progressive livre dysfunction 2/2 prolonged PN

PNALD Sx

• conjugated hyperbilirubinemia (cholestasis)

• ↑ LFTs

• hepatic steatosis

• fibrosis

• cirrhosis

diagnostic criteria for PNALD

d-bili ≥ 2 mg/dL after ≥ 2 weeks PN if other causes excluded

risk factors for PNALD

• ELBW infants

• VLBW infants

• prematurity

• NEC

• SBS

• intestinal atresia

• gastroschisis

• jejunal/ileal resection

• severe feeding intolerance

• chronic intestinal failure

• long PN duration (≥ 2 weeks)

• recurrent sepsis

key etiologies of PNALD

• lack of EN

• excessive lipid

• excess kcal

• prematurity

• sepsis

• intestinal failure

• nutrient deficiencies

• bacterial overgrowth

• prolonged PN use

• liver enzyme abnormalities

what nutrition intervention just like in the case of PNAC can help to prevent PNALD

tiny trophic feeds to stimulate the gut

most common manifestation of PNALD in the NICU

PNAC

key nutrient deficiency that can cause hepatic steatosis and how

choline deficiency

• impaired VLDL formation

• fat trapped in hepatocytes

• hepatic steatosis

other nutrient deficiencies that can cause hepatic steatosis

• taurine

• carnitine

• vitamin E