Iranian Journal of Neonatology

Iranian Journal of Neonatology

An Adequate Increase in Incremental Feeding Rate May be Useful in Reducing the Incidence of Parenteral Nutrition-associated Cholestasis in Preterm Infants with Birthweight Less than 1500g

Document Type : Original Article

Authors
Nan Wang
Yanbo Cheng
Department of Pediatric Gastroenterology, Hepatology and Nutrition, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, 450003, China
10.22038/ijn.2026.87301.2683
Abstract
Background: Parenteral nutrition-associated cholestasis (PNAC) is one of the most challenging complications of prolonged parenteral nutrition (PN). Limited data are 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, and 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. Conditional logistic regression was used to identify the independent association of EN strategies with PNAC.
Results: A total of 66 subjects were studied. Univariate analysis revealed that incremental feeding rate, average feeding amounts, average caloric intake via the enteral route, episodes of EN interruption, and days to start EN were similar before the onset of PNAC between groups. Feeding amounts and caloric intake via the enteral route were also 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).
Conclusion: Incremental feeding rate may be associated with the development of PNAC in preterm infants. Our findings suggest 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.
Keywords
Enteral feeding advancement rates
Enteral nutrition
Extremely low birth weight infants
Parenteral nutrition-associated cholestasis
Very low birth weight infants
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Iranian Journal of Neonatology
Volume 17, Issue 3
Summer 2026
Pages 22-29