Decreased cholestasis with enteral instead of intravenous protein in the very low-birth-weight infant

Marilyn R. Brown, Barbara J. Thunberg, Leonard Golub, William M. Maniscalco, Christopher Cox, Donald L. Shapiro

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


Thirty to 50% of very low-birth-weight infants have parenteral nutrition-associated cholestasis. To test the hypothesis that the incidence of cholestasis would be decreased if parenteral amino acids were avoided and protein given enterally, infants with a gestational age of <30 weeks were randomized to two groups. One group received amino acid-free parenteral nutrition and whey protein enterally with added premature infant formula. The control group received standard parenteral nutrition with amino acids and enteral premature formula. At the end of 3 weeks of parenteral nutrition, infants who had a direct serum bilirubin level of >3 mg/dl were considered to have significant cholestasis. Twenty-nine infants required parenteral nutrition for 3 weeks, 17 in the whey group and 12 in the control group. No instances of significant cholestasis were observed in the whey group (0/17), whereas seven of 12 infants (58%) in the amino acid control group had cholestasis (p < 0.001).

Original languageEnglish (US)
Pages (from-to)21-27
Number of pages7
JournalJournal of pediatric gastroenterology and nutrition
Issue number1
StatePublished - Jul 1989
Externally publishedYes


  • Cholestasis
  • Intravenous amino acids
  • Parenteral nutrition
  • Protein
  • Very low-birth-weight infant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology


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