Long-term parenteral nutrition and delayed establishment of enteral nutrition in extremely low birth weight infants with high enterostomy site is associated with prolonged cholestasis
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In brief
In brief
This retrospective study examines cholestatic liver damage in extremely low birth weight infants after enterostomy. Prolonged parenteral nutrition and delayed enteral feeding, particularly in infants with higher enterostomy sites and lower birth weights, significantly increased cholestasis risk and reduced survival rates.
- Prolonged cholestasis in ELBWIs with enterostomy is associated with significantly lower survival (52.4% vs 88.9%).
- Higher enterostomy site (shorter residual bowel length) correlates with prolonged cholestasis and delayed enteral feeding.
- Duration of parenteral nutrition is an independent risk factor for prolonged cholestasis in ELBWIs post-enterostomy.
- Early establishment of enteral feeding (>100 ml/kg/day) may help prevent prolonged cholestatic liver damage.
- Lower birth weight (<600g) increases risk of cholestatic complications following neonatal enterostomy.
Written by the GCMD Library team from the article.
Abstract
Purpose
Cholestatic liver damage is frequently observed in extremely low-birth-weight infants (ELBWIs) followed by enterostomy. We retrospectively investigated the factors related to liver damage.
Methods
ELBWIs who underwent enterostomy at our institution between January 2013 and December 2022 for gastrointestinal disease during the neonatal period were reviewed. Cases presenting with direct bilirubin > 2.0 mg/dl for > 1 month after enterostomy were designated as the prolonged cholestatic liver (p-CL) group and compared with cases without cholestatic liver damage, the (non-CL) group.
Results
Thirty-nine patients (21 in the p-CL group and 18 in the non-CL group) were included. Survival was significantly lower in the p-CL group (52.4% [11/21] vs. 88.9% [16/18]; p = 0.020). Significant differences were found in the birth weight (587.8 g vs. 698.0 g, p = 0.040) and small intestinal length to the enterostomy (47.6 cm vs. 72.8 cm, p = 0.004). Patients in the non-CL group started enteral feeding and reached > 100 ml/kg/day earlier than those in the p-CL group.
The length of time with parenteral nutrition was an independent risk factor for prolonged cholestasis (p = 0.02).
Conclusion
The birth weight and stoma site level may affect time with PN and enteral feeding management, subsequently resulting in prolonged cholestatic liver damage in ELBWIs with high prematurity.