Gram‐negative Microbiota Blooms in Premature Twins Discordant for Parenteral Nutrition‐associated Cholestasis

ABSTRACT Parenteral nutrition‐associated cholestasis (PNAC) causes serious morbidity in the neonatal intensive care unit. Infection with gut‐associated bacteria is associated with cholestasis, but the role of intestinal microbiota in PNAC is poorly understood. We examined the composition of stool microbiota from premature twins discordant for PNAC as a strategy to reduce confounding from variables associated with both microbiota and cholestasis. Eighty‐four serial stool samples were included from 4 twin sets discordant for PNAC. Random Forests was utilized to determine genera most discriminatory in classifying samples from infants with and without PNAC. In infants with PNAC, we detected a significant increase in the relative abundance of Klebsiella, Veillonella, Enterobacter, and Enterococcus (P