Background: Parenteral nutrition-associated cholestasis (PNAC) is one of the most challenging complications of prolonged parenteral nutrition (PN). Limited data is available regarding the association between enteral nutrition (EN) and PNAC. We aimed to explore the correlation of EN strategies with PNAC in preterm infants with birth weight less than 1500 g.

Methods: A nested case-control study (1:1) was performed including infants with gestational age (GA) < 37 weeks, birth weight (BW) < 1500 g, duration of PN ＞ 7 days. GA, BW, and duration of PN were used as matching criteria. EN strategies before the onset of PNAC were described. A conditional logistic regression was used to identify the independent association of EN strategies and PNAC.

Results: A total of 66 subjects were studied. Univariate analysis revealed that incremental feeding rate, average feeding amounts, average caloric intake via enteral route, episodes of EN interruption, and days to start EN were similar before the onset of PNAC between groups. Also, feeding amounts and caloric intake via enteral route were similar at the onset of PNAC between groups. On logistic regression, incremental feeding rate was negatively associated with PNAC (OR: 0.479, 95%CI: 0.272-0.844, p=0.011).

Conclusions: Incremental feeding rate may be associated with the development of PNAC in preterm infants. Our finding suggests that an adequate increase in incremental feeding rate may be useful in reducing the incidence of PNAC in preterm infants with birth weight less than 1500 g.