Aim of the study. Infants with biliary atresia (BA) frequently have an impaired nutritional status at the moment of Kasai hepatoportoenterostomy (KPE), possibly exerting negative effects on short- and long-term outcome. We analysed perioperative nutritional status and growth of infants undergoing KPE.
Methods. All BA infants who underwent KPE in our centre from 2008-2017 were retrospectively included. We reported anthropometric measurements, including mid upper arm circumference (MUAC) and weight, and nutritional status at admission and one, four and eight weeks post-surgery. Throughout the study adequate nutrition was defined as 130 kcal/kg/day and 3.0 protein(g)/kg/day.
Main Results. We included 49 infants (14M/35F), mean 60 days (±17) of age at KPE. Upon admission, mean z-scores for weight and mid upper arm circumference (MUAC) were -0.56 (±1.18) and -1.94 (±0.74) (p=0.011). After KPE z-scores declined but reached preoperative values again at four weeks post-surgery (Figure). Up to eight weeks post-surgery, MUAC z-scores were lower than weight z-scores. At admission, all infants were fed with breast milk or standard formula. After KPE, all infants received diet formula (Heparon Junior®). At admission, one, four and eight weeks 21, 48, 61, 34% of infants met adequate feeding intake. One week post-surgery, 53% of infants was fed orally [breast/bottle] and 47% received tube feeding [nasogastric/parenteral], 27% and 68% resp. reached adequate nutrition (p=0.015).
Conclusions. Most BA infants are malnourished at the moment of KPE. MUAC reflects the state of (mal)nutrition more accurately than weight. During the early post-operative phase, a major fraction of infants, especially those regularly fed, do not obtain adequate nutritional intake. Therefore, aggressive perioperative nutritional care seems warranted.