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Breastmilk and medium-chain triglyceride supplementation: Retrospective study on outcomes in biliary atresia infants

Thora Wesenberg Helt1,2, Ruben H de Kleine3, Lars Søndergaard Johansen2

  • 1Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark.

Journal of Pediatric Gastroenterology and Nutrition
|February 23, 2026
PubMed

Insights

Breast milk and medium-chain triglyceride (MCT) supplementation after Kasai surgery for biliary atresia (BA) support growth and improve surgical outcomes. Infants receiving breast milk showed better length-for-age z-scores and lower bilirubin levels.

Area of Science:

  • Pediatric surgery
  • Gastroenterology
  • Nutritional science

Background:

  • Biliary atresia (BA) is a severe neonatal liver disease requiring surgical intervention.
  • The Kasai procedure (hepato-portoenterostomy) is the primary surgical treatment for BA.
  • Post-surgical nutritional support is critical for growth and recovery in BA patients.

Purpose of the Study:

  • To investigate the relationship between post-surgical feeding regimens and growth outcomes in children with BA after the Kasai procedure.
  • To evaluate the impact of breast milk intake and medium-chain triglyceride (MCT) supplementation on surgical outcomes in BA patients.

Main Methods:

  • Retrospective analysis of 116 children with BA who underwent Kasai surgery in Denmark and the Netherlands (2014-2022).
  • Joint modeling of longitudinal and survival data to assess the effect of breast milk intake on anthropometry.
  • Mixed linear models used to evaluate surgical outcomes and anthropometry in relation to breast milk and MCT intake, adjusted for calorie intake.

Main Results:

  • Children receiving breast milk post-Kasai maintained stable length-for-age z-scores (LAZ) over 12 months, unlike those without breast milk (LAZ decreased by -0.48).
  • Infants receiving breast milk for at least 1 month had significantly lower total bilirubin at 3 months (79 vs. 116 µmol/L, p=0.028) and reduced cholangitis incidence.
  • Lower LAZ was observed in children with <40% MCT intake compared to those with ≥40% MCT intake.

Conclusions:

  • Post-surgical feeding regimens, including breast milk and adequate MCT levels, significantly impact growth and surgical outcomes in children with BA after Kasai.
  • Further randomized controlled trials are warranted to confirm the benefits of breast milk and varying MCT levels.
Abstract

Keywords:
anthropometrybreastfeedingfeeding methods after Kasaipediatric liver disease

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