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.