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

Cholestasis is an uncommon but potentially life-threatening clinical condition in the neonatal period, leading to maldigestion/malabsorption of fats and fat-soluble components of the diet. Thus, nutritional management is crucial for the cholestatic newborn in order to sustain growth and development. Even if it can be recognized a wide variety of diseases underlying neonatal cholestasis, from a nutritional point of view, patients can be categorized into two main groups, according to their intestinal integrity in length and function, which influences the nutritional strategies to be used: patients with intestinal failure-associated liver disease (IFALD) and those suffering from liver dysfunction without intestinal impairment (NOT IFALD). For both groups, enteral nutrition is widely considered a cornerstone of their care. In this narrative review, we summarize the evidence that guides neonatologists in the complex management of enteral nutrition in a cholestatic newborn, such as the choice of type of milk to be used or of any supplementation needed, focusing on preventive and curative strategies including their effects on sustaining growth. Analyzing data published over a period of more than 50 years, despite the agreement of experts and societies in many aspects of management of both IFALD and NOT IFALD cholestatic newborns, we found that robust evidence behind clinical practice is still lacking. This underscores the urgent need for well-designed multicenter randomized controlled trials to optimize the nutritional care of this vulnerable patient population.