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Cholestasis in immature newborn infants: is parenteral alimentation responsible?
Insights
Early fasting, not intravenous nutrition, may cause intrahepatic cholestasis in premature infants. Prolonged inability to feed orally appears linked to liver issues in these vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Hepatology
Background:
- Intrahepatic cholestasis has been suspected to be linked to intravenous alimentation in premature infants.
- This study investigates the role of nutrition and feeding methods in cholestasis development.
Purpose of the Study:
- To determine if intravenous alimentation (FreAmine and/or Intralipid) is associated with intrahepatic cholestasis in premature infants.
- To explore the relationship between feeding methods, fasting, and hepatic pathology in this population.
Main Methods:
- Retrospective analysis of 15 premature infants (≤30 weeks gestation, birth weight ≤1,250 gm) who survived at least five days and underwent autopsy.
- Clinical data, including feeding methods (oral, nasogastric, intravenous), duration of fasting, and presence of cholestasis and hepatic pathology, were reviewed.
Main Results:
- Cholestasis was observed in 9 of 15 infants. Severe hepatic pathology correlated with poorer nutrition and smaller liver size.
- No correlation was found between the use of intravenous FreAmine or Intralipid and cholestasis.
- Infants with cholestasis could not sustain oral/nasogastric feedings for over 17 days, unlike those without cholestasis who fed orally within 8 days.
Conclusions:
- Early prolonged fasting, rather than parenteral supplementation, may be a significant factor contributing to impaired hepatobiliary function in small premature infants.
- The inability to initiate and sustain oral or nasogastric feeding early in life is strongly associated with cholestasis in this cohort.
Abstract:
This report is a response to the suggestion, first raised in The Journal in 1971, 1 that intravenous alimentation may be responsible for intrahepatic cholestasis in premature infants. Nine of 15 premature infants (30 weeks' gestation or less, birth weight up to 1,250 gm) who survived at least five days and were autopsied were found to have cholestasis. The most severe hepatic pathology was found in the infants whose nutrition was poorest and whose livers were smallest. Both groups had a variety of other clinical problems, especially respiratory distress, intracranial hemorrhage, and infection; it was the first of these that prevented oral feeding in most instances. No correlation was found between treatment with intravenous FreAmine and/or Intralipid and the presence of cholestasis. None of the affected patients, however, could sustain oral or nasogastric feedings during the first seventeen days of life, whereas all surviving patients without cholestasis were able to feed orally within eight days. Fasting later in the course had no effect. Therefore, early fasting, rather than parenteral supplementation, may contribute to impaired hepatobiliary function in the small premature infant.