Enteral Nutrition in Neonatal Cholestasis: An Up-to-Date Overview

Area of Science:

• Neonatology
• Pediatric Gastroenterology
• Nutritional Science

Background:

• Cholestasis in newborns is a critical condition impacting nutrient absorption and growth.
• Effective nutritional management is essential for cholestatic infants, influencing long-term outcomes.
• Patients are categorized as having intestinal failure-associated liver disease (IFALD) or liver dysfunction without intestinal impairment (NOT IFALD), guiding nutritional strategies.

Purpose of the Study:

• To review and summarize evidence guiding enteral nutrition in cholestatic newborns.
• To identify knowledge gaps and areas needing further research in neonatal cholestasis nutritional care.
• To provide insights into preventive and curative nutritional strategies for sustaining growth.

Main Methods:

• This is a narrative review analyzing data published over 50 years.
• The review synthesizes expert and societal agreements on managing IFALD and NOT IFALD cholestatic newborns.
• Focus is placed on enteral nutrition strategies, including milk choices and supplementation.

Main Results:

• Enteral nutrition is a cornerstone in managing both IFALD and NOT IFALD cholestatic newborns.
• Despite expert consensus, robust evidence supporting current clinical practices is limited.
• Existing data highlights the need for improved nutritional strategies to support growth.

Conclusions:

• Optimizing enteral nutrition for cholestatic newborns requires more rigorous scientific investigation.
• Well-designed multicenter randomized controlled trials are urgently needed.
• Evidence-based guidelines are crucial for the nutritional care of this vulnerable population.