Pediatrics 1979 Sep;64(3):342-7

Intrahepatic cholestasis associated with parenteral nutrition in prematur
infants.

Beale EF, Nelson RM, Bucciarelli RL, Donnelly WH, Eitzman DV

Abstract
Sixty-two premature infants less than 2,000 gm birth weight received parenteral
nutrition (PN) during periods of respiratory distress with feeding intolerance.
Intrahepatic cholestasis (direct bilirubin greater than or equal to 1.5 mg/dl)
associated with PN developed in 14 or 23% of these infants. The mean time on PN
to onset of cholestasis was 42 days, and the cholestasis persisted as long as
the infants continued to receive PN. All five infants who had serial follow-up
laboratory studies showed an eventual return of direct bilirubin levels to
normal. The direct bilirubin level appeared to be the best clinically available
test to monitor for the onset and to follow the resolution of this complication.
The very low birth weight infants less than 1,000 gm appeared to be at an
increased risk of developing cholestasis with an incidence of 50%. However,
there was no correlation between the length of time PN was administered to onset
of cholestasis and the gestational age or birth weight of the infants. These
tiny premature infants also received PN for significantly longer periods of
time, and the longer the infusions were administered the greater was the risk of
cholestasis developing.