# Nutrition Support Adequacy in Children with Biliary Atresia After Liver Transplant

## TL;DR

This study examines how well children with biliary atresia receive nutrition after liver transplants, finding that younger infants meet nutritional goals better than older children.

## Contribution

The study provides new insights into age-related differences in nutrition support adequacy after liver transplants in children with biliary atresia.

## Key findings

- Combined enteral and parenteral nutrition achieved near-complete energy and protein goals in the first week post-transplant.
- Infants under one year met nutritional goals significantly better than older children.
- Nutritional support remains challenging for older children after liver transplantation.

## Abstract

Background: The nutrition support of children with biliary atresia after liver transplant is affected by multiple factors, and a connection between these factors and conditions present before transplant can potentially make the nutrition support more challenging. We aim to assess the adequacy of nutrition support, specifically energy and protein, during the first week of admission to the Pediatric Intensive Care Unit (PICU) in children after liver transplant secondary to biliary atresia. Methods: We performed a retrospective cohort study of 138 patients [13.9 median (9–33.4) IQR months; 62% female] with a diagnosis of biliary atresia admitted to the PICU after liver transplantation at Texas Children’s Hospital over a 14-year study period. We obtained nutrition adequacy of enteral and parenteral nutrition support for the first week after transplant during their PICU admission. Results: Goal adequacy was reached at the end of the first week of admission when combined enteral and parenteral nutrition support was provided (median 98% for energy and 101% for protein). Infants achieved significantly higher adequacies than older children during the first week (136% < 1 year vs. 0% > 1 year, p < 0.001 for calories, and 157% < 1 year vs. 0% > 1 year for protein; p < 0.01). Conclusions: These findings highlight the complex nutritional challenges faced by this population, and strategies are needed to meet the unique needs of children after liver transplantation.