Cholestasis in immature newborn infants: is parenteral alimentation responsible?

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.