Cholestasis and hepatic dysfunction associated with parenteral nutrition in a tertiary neonatal intensive care unit...

Retrospective audit of neonatal intensive care unit (NICU) guidelines for evaluation of cholestasis identified a sub-group fulfilling definitions of intestinal failure and intestinal failure-associated liver disease.

Babies admitted to NICU between 2008 and 2022, with conjugated bilirubin ≥ 20 µmol/L and fractionated total bilirubin ≥ 20 % were identified. Infants who received prolonged parenteral nutrition (PN ≥ 30 days) were compared by presence or absence of gastrointestinal (GI) disease.

Of 208 infants with cholestasis, 99 (47.6 %) received prolonged PN. No GI disease was present in 39 (39.4 %). Stoma were present in 46 of 60 (76.7 %) infants with GI disease. Both groups were equally very preterm and extremely low birth weight, with no statistical difference in co-morbidities of cytomegalovirus infection, hypothyroidism, endotracheal ventilation, septicaemia, or necrotising enterocolitis. There was no statistical difference in median age at cholestasis onset (36 vs 44 days), peak bilirubin (139 vs 130 µmol/L), peak GGT (219 vs 224 IU/L), peak AST (182 vs 148 IU/L), hepatic coagulopathy (35 % vs 20.5 %) or time to normalisation of liver function tests (141 vs 112 days) between infants with or without GI disease. Infants with GI disease had greater PN exposure (median 72 vs. 40 days, p < 0.0001), development of IFALD (56.7 % vs 15.4 %, p < 0.0001) and more remained on PN at death (21.7 % vs 7.7 %, p = 0.01). No infants died from liver disease.

Prolonged PN exposure in very premature and low birth weight babies without GI disease is associated with hepatic dysfunction comparable to equal peers with GI disease.