Pediatric total parenteral nutrition. Liver histopathology.

Correlation of clinical data with hepatic histopathology from 31 infants receiving total parenteral nutrition (TPN) suggest chronologic progression of liver disease with long-term TPN. Steatosis and a prominent eosinophil component in portal-tract extramedullary hematopoiesis appear during the first five days of TPN. The former persists for 90 days, the latter for three weeks. Canalicular cholestasis was present after ten days in 84.2% of the livers studied and bile duct proliferation in 63.6% after three weeks of TPN. Moderate to severe portal fibrosis only occurred after 90 days, whereas micronodular cirrhosis developed in one patient after five months of TPN. Lipofuscin-like pigment and hemosiderin were each demonstrated in 90.3% of the livers studied. Our findings suggest that with up to 90 days of TPN most changes should either be reversible or not severe enough to result in liver failure.