Journal of Ultrasound in Medicine, Vol 6, Issue 5 243-248, Copyright © 1987 by American Institute of Ultrasound in Medicine
Total parenteral nutrition (TPN) and gallbladder diseases in neonates. Sonographic assessment
C. Matos, E. F. Avni, D. Van Gansbeke, A. Pardou and J. Struyven
During a 1-year period, a prospective ultrasound (US) study of the biliary
tract was performed in 41 neonates receiving total parenteral nutrition
(TPN). Gallbladder sludge appeared in 18 neonates (44%) after a mean period
of 10 days of TPN. The occurrence of this abnormality seems related to
three main factors: prematurity with immaturity of the enterohepatic
circulation of bile acids, duration of TPN, and lack of enteral nutrition.
In five neonates (12%), an evolution of sludge to "sludge balls" was
observed. Two neonates (5%) went on to develop uncomplicated gallstones and
a spontaneous resolution occurred in one of them 6 months after the
examination. This finding suggests conservative management in such cases.
However, since cholecystitis or biliary tract obstruction are classical
complications in older children, a US survey of neonates receiving TPN is
useful to follow the abnormal gallbladder content, and rapid introduction
of enteral feeding is advisable.
