Background:   In a previously conducted multicenter (n=11 sites), randomized clinical trial, our research group measured the effect of two distinct strategies of parenteral nutrition supplementation on blood amino acid profiles and on growth from birth to 28 days of life.   Infants with a gestational age 23 to 29 6/7 wks, with no history of biliary atresia or viral hepatitis, received one of two parenteral nutrition approaches.

Objective:  To evaluate the impact of delayed enteral feeding on the development of cholestasis in preterm neonates receiving parenteral nutrition. 

Design/Methods:  The demographic characteristics of the neonates who developed cholestasis were compared with those who did not develop cholestasis. Categorical variables were evaluated using a two-tailed Chi-square and Fisher's Exact Tests. Continuous variables were compared using a two-tailed t-test for parametrically distributed data or Kruskal-Wallis ANOVA for non-parametrically distributed data. Rank data were assessed using a two-tailed Mann-Whitney nonparametric test.

Results:  Of the 122 neonates enrolled in the study; 13 (11%) developed cholestasis.  Cholestasis developed in 4 of 84 (4.8%) of the neonates who were receiving enteral feedings by 7 days of age and 9 of 37 (24.3%) of the neonates who were not receiving enteral feedings by 7 days of age (p = 0.003).  Neonates who developed cholestasis were more immature, had a lower birth weight, had a higher cumulative dose of amino acids, more often had a patent ductus arteriosus, more often had severe intraventricular hemorrhage, and were more commonly treated with steroids by 28 days of age.

Conclusions:  Cholestasis remains an important complication of parenteral nutrition.  Early feeding may have a protective role in preventing cholestasis.