The Risk Factors of Parenteral Nutrition-associated Cholestasis in Preterm Infants

Preterm infants are at a higher risk for developing nutritional compromise because of limited nutrient reserves, immature gastrointestinal function, and greater nutrient demands. The introduction of parenteral nutrition (PN) in early postnatal life has improved their mortality and morbidity and is now widely used in neonatal intensive care units (NICUs). However, prolonged PN is associated with a wide spectrum of hepatobiliary derangements, and cholestasis is a major complication in preterm infants. Parenteral nutrition-associated cholestasis (PNAC) is defined as cholestasis (conjugated bilirubin ≥ 2.0 mg/dL) that is associated with a prolonged duration of PN administration (usually > 2 weeks). 1,2 Accurate diagnosis should be made only after other known causes of cholestasis have been excluded.