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.

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.