In premature neonates, what is a primary risk factor for cholestasis?

In premature neonates, what is a primary risk factor for cholestasis?

• A. Prolonged phototherapy
• B. Infection with CMV
• C. Long term parenteral nutrition
• D. Maternal diabetes

Answer: (C)

Long-term parenteral nutrition is the main factor driving cholestasis in premature neonates. When feeding is delivered intravenously, the gut is not stimulated to secrete bile acids or release cholecystokinin, so bile flow through the hepatic ducts declines. In premature infants, the liver and bile excretion pathways are already immature, making them especially susceptible to injury from prolonged PN. Over weeks of PN, this can lead to cholestasis with elevated direct bilirubin. In contrast, infections like CMV, maternal diabetes, or phototherapy aren’t the primary drivers of cholestasis in this population.

Long-term parenteral nutrition is the main factor driving cholestasis in premature neonates. When feeding is delivered intravenously, the gut is not stimulated to secrete bile acids or release cholecystokinin, so bile flow through the hepatic ducts declines. In premature infants, the liver and bile excretion pathways are already immature, making them especially susceptible to injury from prolonged PN. Over weeks of PN, this can lead to cholestasis with elevated direct bilirubin. In contrast, infections like CMV, maternal diabetes, or phototherapy aren’t the primary drivers of cholestasis in this population.