Neonatal Cholestasis as a Side Effect of Ketogenic Diet

The ketogenic diet has emerged as a therapeutic intervention for refractory seizures in infants, but its efficacy and safety in neonates are not well established. We present the case of a small for gestational age newborn who was admitted to the neonatal department at 8 hours of age for hypoglycemia. On admission, he began to have seizures, and despite escalation of antiepileptic drug treatment, they still persisted. As a consecuence, the ketogenic diet was started at 14 days of age. While this treatment improved seizure control, the patient developed significant jaundice and cholestasis 15 days after starting the ketogenic diet. Despite treatment, cholestasis persisted, and the ketogenic diet was discontinued at 46 days of age. This case highlights the importance of vigilant monitoring for potential adverse effects of the ketogenic diet in neonates, underlines the infrequency of cholestasis as a significant complication, and emphasises the need for close monitoring of liver function in neonates undergoing ketogenic therapy.