Journal of pediatric gastroenterology and nutrition
October 21, 2026 · via Europe PMC
Incidence and risk factors of parenteral nutrition-associated cholestasis in surgical very low birth weight infants.
Kim W, Park S, Bang MJ, Son J, Lee S, Seo JM.
AI summary — for doctors, generated from the abstract only
About half of surgical very low birth weight infants developed parenteral nutrition-associated cholestasis despite SMOFlipid, strongly tied to intestinal failure and slow enteral feeding.
What was studied
Retrospective review of 61 VLBW infants after surgery for NEC, spontaneous intestinal perforation or meconium-related ileus, with PNAC defined by persistent direct bilirubin of 2.0 mg/dL or more.
Key findings
- 30 of 61 infants (49%) developed PNAC, with 70% occurring within 8 weeks of PN start.
- Inability to reach full enteral feeding within 6 weeks was independently associated with PNAC.
- Fish oil monotherapy rarely reversed severe cholestasis.
Clinical relevance
Neonatal teams should expect high PNAC rates in this group and prioritize feeding advancement and early intestinal rehabilitation referral.
Who should care
Limitations
Small single-center retrospective sample, and feeding failure likely reflects disease severity rather than being a modifiable cause.
Monitor direct bilirubin closely and push enteral feeding early, recognizing that lipid changes alone may not prevent or reverse severe cholestasis.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Objectives
Surgical intervention for necrotizing enterocolitis (NEC), spontaneous intestinal perforation (SIP), and meconium-related ileus (MRI) is frequently complicated by parenteral nutrition-associated cholestasis (PNAC). This study aimed to determine the incidence and identify risk factors of PNAC in very low birth weight (VLBW) infants following gastrointestinal surgery.
Methods
We conducted a retrospective review of medical records for VLBW infants who underwent gastrointestinal surgery between January 2012 and December 2020. PNAC was defined as direct bilirubin ≥2.0 mg/dL persisting for two postoperative weeks while on PN.
Results
Among 61 VLBW patients who underwent surgery for NEC, SIP, or MRI, 30 (49%) developed PNAC. The median duration of PN until PNAC onset was 6 weeks, and 70% developed cholestasis within 8 weeks of PN initiation. Intestinal failure was present in 79% of the cohort and was significantly more frequent in infants with PNAC. Inability to achieve full enteral feeding within 6 weeks was independently associated with PNAC. Despite routine use of SMOFlipid, PNAC incidence remained substantial. Among infants with severe cholestasis (direct bilirubin ≥6 mg/dL), switching to fish oil monotherapy rarely resulted in reversal.
Conclusion
PNAC developed early and frequently in surgical VLBW infants despite SMOFlipid use and was strongly associated with intestinal failure and inability to achieve full enteral feeding. Early feeding progression appears to reflect overall disease severity and may represent an important clinical marker for PNAC risk.
DOI
10.1002/jpn3.70607
PMID
42904576
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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