Admission of all gestations to a regional neonatal unit versus controls: Neonatal morbidity

Aims:   To describe the neonatal course and morbidity of all infants admitted to the regional neonatal intensive care unit (NICU) at Christchurch Women's Hospital (CWH) and to compare these with term control infants who were not admitted, in one calendar year. Infants in both NICU and control cohorts were enrolled in a 2-year follow-up study.
Methods:   All infants born over a 12-month period from February 2001 and admitted to the NICU, whose parents were domiciled in a defined geographical region, were eligible for study, together with every eighth healthy infant born at term and not admitted (to a total of 300). Comprehensive perinatal and neonatal data were collected for all enrolled infants.
Results:   A total of 387 NICU infants (86% eligible) were enrolled in the study together with 306 controls. Forty-one percent of NICU admissions were term and 40% were 33–36 weeks gestation. Term NICU infants were more likely to be born following induction of labour or by Caesarean section (34%, of which 50% were pre-labour) than control infants (18%, of which 32% were pre-labour). Infants of <28, 28–32, 33–36 and ≥37 weeks accounted for 74, 16, 7 and 3% of assisted ventilation days and 18, 31, 31 and 20% of total baby days, respectively.
Conclusions:   The need for assisted ventilation and length of NICU stay was inversely proportional to gestation. However, preterm infants of 28 weeks gestation and greater, as well as term infants, account for a high proportion of the NICU workload.     

Admissions of all gestations to a regional neonatal unit versus controls: 2-year outcome

Aims:   To assess neurodevelopmental outcome at 2 years for neonatal intensive care unit (NICU) admissions compared with controls, and to trial a parent-reporting scheme.
Methods:   All infants admitted to the NICU at Christchurch Women's Hospital over a 12-month period and whose parents were domiciled in a defined geographical region were eligible for study, together with every eighth term infant not admitted (to a total of 300). Parents completed a two-page questionnaire on their child's 2nd birthday. All infants <28 weeks gestation and a random 300 NICU admissions and 108 controls underwent a paediatric examination and Bayley II assessment at 2 years of age.
Results:   A total of 387 NICU infants (86% eligible) and 306 controls were enrolled. At 2 years of age, 276 NICU infants (89% survivors) and 94 controls (87%) had some follow up. For infants of <33 weeks, 33–36 weeks, ≥37 weeks gestation and controls, the percentage >1 SD below the mean on the Bayley Mental Development Index scales were 33.3, 36.5, 44.6 and 24.1, respectively ( P = 0.03); on the Psychomotor Developmental Index scales were 30.0, 29.1, 41.1 and 19.5 ( P = 0.02) and the percentage with any cerebral palsy were 11.1, 2.8, 5.2 and 1.2.
Conclusions:   At 2 years of age, NICU graduates have more developmental problems than controls across a range of measures. In many cases, term NICU graduates have the least favourable outcome. There was only moderate agreement between parents' reporting of moderate or severe developmental disability by means of a questionnaire, compared with professionals (kappa statistic 0.38), with parents tending to underestimate problems.     

Single versus bihemispheric amplitude-integrated electroencephalography in relation to cerebral injury and outcome in the term encephalopathic infant

Background:   The demand for early diagnosis and prognostication of cerebral injury in the encephalopathic term infant is increasing to facilitate appropriate management. The single-channel amplitude-integrated electroencephalogram (S-aEEG) has been shown to have predictive utility for the severely encephalopathic infant. New bedside aEEG devices with more channels are entering the neonatal environment. Little data are available to compare the utility of two channels (B-aEEG) with that of an S-aEEG recording.
Aim:   To compare the utility of the S-aEEG and the B-aEEG in the prediction of cerebral injury, as determined by magnetic resonance imaging (MRI), and neurodevelopmental outcome in the term encephalopathic infant.
Methods:   Term encephalopathic infants, with or without seizures, admitted to a level III NICU were included in this study. These infants had simultaneous S-aEEG and B-aEEG recordings. MRI was undertaken during the clinical course and classified as to the extent of cerebral injury. Neurological outcome was assessed at 2 years of age.
Results:   Twenty-eight encephalopathic term infants were included in the study. There was high level of agreement between both brain monitors (Kappa = 0.68, P  < 0.001), but there was disagreement in the classification in four cases where the S-aEEG was normal when the B-aEEG was severely abnormal (McNemar's test P  = 0.046). Of note in these four cases, all had a severely abnormal MRI and poor neurodevelopmental outcome at 2 years.
Conclusion:   Amplitude measurements by the B-aEEG appear more sensitive in detecting cerebral injury in comparison with the S-aEEG, particularly in the setting of unilateral injury.     

Neonatal cholestasis: differentiation of biliary atresia from neonatal hepatitis in a developing country

Aim:  To study the accuracy of various clinical and investigational parameters to differentiate biliary atresia (BA) from neonatal hepatitis (NH).
Methods:  It was a prospective study, conducted in a tertiary care hospital. A total 101 infants with neonatal cholestasis (NCS) were included in this study. Following a baseline hepatobiliary scintigraphic study (HBS), it was repeated after giving UDCA (40 mg/kg/day for 48–72 h). The sensitivity and specificity of clinical and investigational parameters were calculated with peroperative cholangiogram as gold standard.
Results:  The mean age was 2.8 ± 1.7 months and 82 were male. Of these, 35 were diagnosed to have BA and 66 had NH (idiopathic 25, sepsis/UTI 20, galactosaemia 11, TORCH 2 and others 8). Persistently clay stool was found to have modest accuracy (79%) and the accuracy of HBS improved significantly following UDCA therapy (91% from 77%, p < 0.01) whereas liver biopsy was 100% accurate in differentiating BA from NH. The outcome of BA cases with ductal plate malformation (DPM) was worse.
Conclusion:  One-third of all NCS in India is due to BA and among the intrahepatic causes acquired infection and galactosaemia are common. Liver biopsy is the best method to differentiate NH from BA.     

Ursodeoxycholic acid (UDCA) therapy in very-low-birth-weight infants with parenteral nutrition-associated cholestasis

OBJECTIVE: To determine the effect of ursodeoxycholic acid (UDCA) in very-low-birth-weight (VLBW) infants with parenteral nutrition-associated cholestasis (PNAC).STUDY DESIGN: A retrospective study of all VLBW infants with PNAC who were admitted to a tertiary referral center was conducted. Patients were classified as treatment group (receiving UDCA within 14 days after onset of cholestasis) or control group (no medical treatment). Patients who received abdominal surgery were excluded. RESULTS: A total of 30 patients were recruited, including 12 in the treatment group and 18 in the control group. The demographic data, total fasting duration, onset of cholestasis, age to tolerance of full feeds, and the duration of parenteral nutrition (PN) before the onset of cholestasis were comparable between the two groups. There was a trend in the control group to later onset of cholestasis. The patients who received UDCA therapy with doses of 10 to 30 mg/kg/day had a shorter duration of cholestasis than the control group (62.8 vs 92.4 days, P=.006). Furthermore, the peak serum levels of direct bilirubin also was significantly lower in the treatment group. CONCLUSION: UDCA can improve the course of PNAC in VLBW infants.     

Pre-admission consultation and late referral in infants with neonatal cholestasis

Aims:   To study factors leading to delayed referral in neonatal cholestasis at a tertiary centre in Malaysia.
Methods:   A prospective, observational study on consecutive infants with neonatal cholestasis referred to a tertiary unit paediatric liver unit in Malaysia.
Results:   Thirty-one of the 65 (43%) patients studied encountered delay or had an inappropriate action taken before referral. Factors leading to delayed referral, which adversely affected the outcome of biliary atresia (BA) and neonatal acute liver failure, were repeated reassurances by medical and paramedical staff ( n  = 17, 26%), failure of hospital services at the referring hospital ( n  = 7, 11%) and parental refusal for referral ( n  = 5, 8%). Only three (14%) of the 22 patients who developed liver failure had liver transplantation (LT). The 1-year survival rate with native liver for BA was 35%, while overall 1-year survival rate (native liver and LT) was 41%.
Conclusions:   Repeated false reassurance, failure of hospital services and parental refusal all contributed to delayed referral in neonatal cholestasis. In addition to education of medical and public health workers, and parents on the importance of early referral in neonatal cholestasis, health authorities in Malaysia should consider the feasibility of universal stool colour screening in newborn infants to improve the outcome of BA.     

Arterial thromboembolic disease: a single-centre case series study

Aim:   Paediatric venous thromboembolic disease has been reported with increased frequency during the last decade. In contrast, the pathophysiology of arterial thromboembolic disease in infants and children has not been adequately explored. The aim of this study was to determine the prevalence, aetiology, diagnostic criteria, management and outcome of arterial thromboembolism (TE) in a tertiary paediatric centre.
Methods:   A prospective, single-centre registry was established at an Australian tertiary paediatric centre in order to address the aim of this study.
Results:   One-hundred-and-two arterial thrombotic events occurred in 98 patients during 48 months. Infants were most likely to have a lower limb arterial TE (n = 22) whilst children were most likely to have a central nervous system arterial TE (n = 26). Surgery was a frequent predisposing factor in both infants and children. Doppler ultrasonography, computerized tomography and magnetic resonance imaging were the most commonly used diagnostic modalities.
Unfractionated heparin was the most frequently used treatment in both age groups. At discharge, 25 infants and twelve children had complete resolution of their arterial TE. Direct thrombosis-related mortality was 4% in infants and 9% in children. Duration of follow-up ranged from 1 to 900 days, with thirteen infants and 32 children never achieving complete resolution. Forty-nine percent of post-discharge survivors had significant long term sequelae directly attributable to their arterial TE.
Conclusion:   Arterial TE occurred as frequently as venous TE in our tertiary paediatric population. The clinical outcome and long term sequelae of such events are significant.     

Oesophageal perforation in preterm neonates: not an innocent bystander

Objective:    To compare the clinical course and neonatal outcomes of preterm infants with oesophageal perforation (OP).
Methods:    Retrospective case control study of infants admitted between 1994 and 2001 and diagnosed with OP was performed at two tertiary care centres in Toronto, Canada. One control per case was matched by the gestational age and the month of birth. Occurrence of air leak syndrome/pleural effusion requiring drainage, the duration of supplemental oxygen and the time to attain full feeds were compared.
Results:    Ten cases of OP were identified. The commonest clinical presentation was air leak syndrome/pleural effusion. There was a statistically significant increase in the time to attain full enteral feeds in OP group ( P  = 0.02). The duration of supplemental oxygen was prolonged in infants with OP, however, this was statistically insignificant ( P  = 0.20). The infants were managed conservatively and perforation healed in all.
Conclusion:    Oesophageal perforation is a rare but important complication of modern neonatal intensive care setting. The diagnosis of OP should be considered in infants who present with sudden/acute deterioration in their respiratory status following procedures involving pharyngeal region. Conservative management in an otherwise uncomplicated case leads to complete recovery in neonates.     

Impact of antenatal diagnosis of hypoplastic left heart syndrome on the clinical presentation and surgical outcomes: The Australian experience

Aim:   Antenatal diagnosis of severe congenital heart disease enables planning of perinatal care of affected infants. Congenital heart surgery is highly centralised in Australia, and surgery for hypoplastic left heart syndrome (HLHS) currently takes place at a single institution, in order to ensure case volume. The study aims to review the impact of antenatal diagnosis on the early clinical course of infants with HLHS in Australia.
Methods:   Retrospective review was performed on all neonates who were admitted for management of HLHS between 2001 and 2005 at the Paediatric Cardiac Surgical Unit, The Royal Children's Hospital, Melbourne, Australia.
Results:   Sixty neonates with HLHS were admitted, in whom an antenatal diagnosis was present in 46 (77%). Treatment was withdrawn in seven infants, of whom three had prenatal, and 4 had post-natal diagnoses. Antenatally diagnosed infants were commenced on prostaglandin earlier than post-natally diagnosed infants (age 1 h and 55 h respectively), and on paediatric intensive care unit admission had a higher pH (7.31 vs. 7.20), a lower lactate (3.0 vs. 6.7), a lower inspired oxygen fraction (0.21 vs. 0.96) and were less likely to be ventilated (10.8% vs. 92.9%). Infants with an antenatal diagnosis had lower peak creatinine (70 vs. 120) and alanine aminotransferase (29 vs. 242). The survival to intensive care discharge and stage 2 palliation was 74% and 68% respectively, and was not influenced by timing of diagnosis.
Conclusions:   Antenatal diagnosis of HLHS was strongly associated with a superior pre-operative clinical status, but did not influence early survival after surgical palliation.     

Comparison of neonatal outcome for inborn and outborn very low-birthweight preterm infants

Background:  The aim of the present study was to compare the neonatal outcome of very low-birthweight (VLBW) preterm infants with regard to inborn and outborn status in a medical center of Southern Taiwan, where short-distance neonatal transport is the rule and maternal transport was not well established.
Methods:  This retrospective study included outborn VLBW preterm infants admitted to the neonatal intensive care unit of Chang Gung Memorial Hospital at Kaohsiung after neonatal transport during the period from 1999 through 2003. An equal number of inborn preterm infants matched for gender and birthweight were included as controls. Infants with lethal congenital anomalies or who died in the delivery room were excluded. Data were collected from reviewing medical charts.
Results:  A total of 34 inborn VLBW infants and 34 outborn VLBW infants with neonatal transport were included. Chronic lung disease (CLD) was significantly more frequent in the outborn group according to McNemar test ( P  = 0.0124) and logistic regression. Logistic regression also showed that outborn status ( P  = 0.0173) and birthweight ( P  = 0.0024) were the two most important risk factors for development of CLD.
Conclusion:  Well-trained short distance neonatal transport is useful and valuable for VLBW infants with gestation age of 27–34 weeks in Southern Taiwan. The respiratory outcome, however, was poor in the outborn group in terms of incidence of CLD. To improve the respiratory outcome, further modification of respiratory care during transportation or antenatal maternal transport is crucial.     

Is thrombocytopenia suggestive of organism‐specific response in neonatal sepsis?

Background:  It is controversial whether thrombocytopenia is suggestive of one (or more) causative agents of neonatal sepsis: a low platelet count has been related in turn to Gram-positive, Gram-negative or fungal sepsis.
Methods:  A retrospective, cohort study on 514 very low-birthweight (VLBW) neonates admitted over a 9 year period to a large tertiary neonatal intensive care unit (NICU) in Italy was carried out. Through database search, data on platelet counts, sepsis, clinical course, and microbiological culture were collected and analyzed. Statistical analysis was performed to look for significant association between thrombocytopenia and sepsis caused by different (Gram-positive, Gram-negative or fungal) organisms.
Results:  Sepsis diagnosed on microbiological criteria occurred in 197 of 514 VLBW neonates (38.3%), and thrombocytopenia (at least one finding of platelet count <80 000/mm³) was detected in 34 (17.2%) of the 197 septic infants. Thrombocytopenia occurred in 10 of 51 neonates with fungal sepsis (19.6%), and in 24 of 146 with bacterial sepsis (16.4%; P  = 0.37). The difference was not significant when clustering for sepsis caused by Gram-positive (nine thrombocytopenic of 51 with Gram-positive sepsis, 17.6%; P  = 0.40) and Gram-negative organisms (15/95, 15.7%; P  = 0.22), or when considering only coagulase-negative Staphylococcus sepsis (6/37, 16.2%; P  = 0.25).
Conclusions:  In contrast with previous reports, thrombocytopenia might not be an organism-specific marker of sepsis. Caution should be maintained in relating a low platelet count to any infectious agent (or group of agents) in preterm VLBW neonates.     

Single-centre vs. population-based outcome data of extremely preterm infants at the limits of viability

Aim:  In response to the disappointing outcome data of the population-based EPICure study published in 2000, we compared the outcome of infants 22 0/7 to 25 6/7 weeks of gestational age (GA) in a single tertiary care centre 2000–2004 with that of EPICure.
Methods:  EPICure tools and definitions, including 30 months' Bayley Scales.
Results:  Of 83 infants <26 weeks born alive, more were admitted to intensive care – 82% vs. 68% (p  <  0.0001) – and more infants survived to discharge (57% vs. 26%, p <   0.0001; 69% vs. 39%, p  <  0.01, of those admitted to intensive care). More infants, as a percentage of live births, survived without severe (41%, 34/83 vs. 20%, 233/1185, p <   0.0001) or overall disability (22%, 18/83 vs. 13%, 155/1185, p  =  0.03). However, at the border of viability – GA 23 and 24 weeks – the rate of infants surviving without overall disability was not significantly higher (13%, 6/45 vs. 9%, 56/623).
Conclusion:  In infants <26 weeks of GA, increased rates of survival and survival without disability were observed in a single-centre inborn cohort born 5–8 years later than the EPICure cohort. This did not translate into increased survival without overall disability in infants of 23–24 weeks of GA.     

Early high C-reactive protein in infants with open abdominal wall defects does not predict sepsis or adverse outcome

Aim:  To study CRP values and relate it to outcome in infants with antenatal diagnosis of gastroschisis, exomphalos and other surgical conditions.
Methods:  Over five years, infants admitted to our neonatal unit with gastroschisis, exomphalos and other surgical diagnoses were identified. Serum CRP measurements in first 5 days were studied. Group one included 33 gastroschisis patients, group two, 18 exomphalos patients, and group three, 38 patients with other surgical diagnoses. Outcome measures included TPN days, time to full feeds and duration of hospitalization.
Results:  Infants with gastroschisis were more premature (36.9 vs 38.1 weeks) with lower birth weights (2515 vs 3078 g), than infants with exomphalos. CRP values on admission in gastroschisis group were significantly higher than exomphalos and other diagnoses groups (33.7 ± 6.4 vs 8.8 ± 6.0 vs 5.7 ± 2.0, respectively, p   <   0.05). All blood cultures were sterile. There was no relationship between high CRP and death or adverse outcome (TPN days, time to full feeds or duration of hospitalization) in the gastroschisis group.
Conclusion:  Infants with gastroschisis exhibit high early CRP, which may not indicate sepsis or adverse outcome. This increase can complicate the assessment of these infants. Clinicians should be aware of this finding as it could inform management decisions in this group.     

Characteristics of hyperthermia and its complications in patients with Prader Willi syndrome

Abstract Background : Thermoregulation problems, resulting in hypo- or hyperthermia, have been infrequently reported in children with Prader Willi syndrome (PWS), yet their clinical details remained unknown.
Methods : The clinical characteristics of three infants with PWS are reported.
Results : Etiologies of high fever could not be identified in three children with PWS. One of these children was also admitted to the intensive care unit with extremely high body temperature in a life-threatening condition, similar to septic shock, without a plausible explanation.
Conclusion : Hyperthermia may be a part of the clinical spectrum in young infants with PWS and should be carefully monitored, since it may cause life-threatening complications.     

Blood pressure support in extremely premature infants is affected by different courses of antenatal steroids

Objective:  To examine the effects of partial, single and multiple courses of antenatal corticosteroids (ANS) on the need for blood pressure support in extremely premature infants.
Methods:  Extremely premature infants with gestational age of 24 to 28 weeks were included in this study during a 5-year period. The main outcome measure of the study was the amount of blood pressure support during the first 3 days of life.
Results:  The study infants (n = 163) were divided into: infants not exposed (ANS; n = 27) and exposed to ANS (ANS; n = 136). Blood pressure support was significantly lower in ANS compared with No ANS (65% vs 96%; p = 0.003) and in single course (SANS; n = 73) and ≥2 courses (MANS; n = 34) compared with partial course of ANS (PANS; n = 29) (62%, 56% vs 86%; p = 0.03). The number of infants who received volume support and the amount of volume support were significantly lower in ANS compared with that in No ANS (p < 0.001) and in SANS and MANS compared with that in PANS (p < 0.02).
Conclusion:  Exposure to multiple courses of ANS was as beneficial as single course of ANS in decreasing the need for blood pressure support in extremely premature infants.     

Promoting shorter duration of ventilator treatment decreases the number of painful procedures in preterm infants

Aim:  To investigate whether promoting shorter ventilator treatment decreases the number of painful procedures and the use of analgesics in preterm infants.
Methods:  Retrospective patient chart review of all preterm infants in one Neonatal Intensive Care Unit (NICU) was carried out in 2000 (n = 240) and 2005 (n = 206). Between these cohorts, early nasal continuous positive airway pressure (nCPAP) application and early extubation policy were introduced.
Results:  Fewer infants were intubated (22 vs. 32%, p = 0.03), the duration of ventilator treatment decreased (6.7 SD 11.3 vs. 9.0 SD 11.1 days, p < 0.001) and nCPAP treatment became more common (41 vs. 25%, p < 0.001) in 2005 than in 2000. Similarly, the infants' exposure to painful procedures did not decrease significantly (61.9 SD 98.5 vs. 67.1 SD 104.3 procedures, p = 0.32) but the procedures related to respiratory support were fewer (45.2 SD 79.5 vs. 68.9 SD 91.1 procedures, p < 0.001) in 2005 than in 2000. In addition, the amount of pain medication used was significantly lower in 2005 than in 2000. One day on a ventilator included more painful procedures than a day on nCPAP (11.2 95% CI: 11.0–11.5 vs. 4.2 95% CI: 4.1–4.4 procedures, p < 0.001) during both study years.
Conclusion:  Early nCPAP and early extubation policies were successfully implemented in an NICU resulting in less invasive respiratory support. This was associated with fewer painful procedures and less pain medication in the preterm infants who required respiratory support. Despite this positive effect, the number of painful procedures in all preterm infants stayed at the same level. Our results provide further support for the use of nCPAP in preterm infants.     

Infants in a neonatal intensive care unit: parental response

OBJECTIVE: To compare the psychosocial functioning of the parents (mother and father) of infants admitted to a neonatal intensive care unit (NICU) with the parents of infants born at term and not admitted to the NICU. DESIGN: Random sample of NICU parents and term non-NICU parents were assessed across a variety of psychiatric and psychosocial measures shortly after the birth of their infant. SETTING: Christchurch Women's Hospital, New Zealand. Labour ward and level III NICU. PARTICIPANTS: A total of 447 parents (242 mothers; 205 fathers) with an infant admitted to a regional NICU during a 12 month period; 189 parents (100 mothers; 89 fathers) with infants born at term and not requiring NICU admission. MAIN OUTCOME MEASURES: Depression and anxiety symptoms, psychosocial functioning. RESULTS: Overall, levels of anxiety and depression were low in both parent groups. Compared with control parents, a higher percentage of NICU parents had clinically relevant anxiety and were more likely to have had a previous NICU admission and be in a lower family income bracket. Infant prematurity was associated with higher levels of symptomatology in both NICU mothers and fathers. CONCLUSIONS: Specific interventions are not needed for most parents who have an infant admitted to the NICU as they appear to adapt relatively successfully. Infant prematurity impacts negatively on the father as well as the mother. Consequently these parents may benefit from increased clinical attention.     

The association between prenatal cocaine exposure and physiological regulation at 13 months of age

Background:  This study examined the association between prenatal cocaine exposure (PCE) and autonomic regulation at 13 months of age.
Methods:  Measures of respiratory sinus arrhythmia (RSA) were obtained from 156 (79 exposed, and 77 nonexposed) infants during baseline and during tasks designed to elicit positive (PA) and negative affect (NA).
Results:  There was a significant suppression of RSA during the negative affect task for nonexposed infants but not for exposed infants. Maternal symptoms of depression or anxiety (MDA) did not mediate this association. However, gender and MDA did moderate this association such that exposed boys and exposed infants whose mothers had higher levels of MDA had an increase in RSA during a task designed to elicit NA rather than the typical pattern of RSA suppression.
Conclusions:  These results suggest that there are several possible pathways from PCE to physiological dysregulation during late infancy.     

The effect of cleft lip and palate, and the timing of lip repair on mother-infant interactions and infant development

Background:  Children with cleft lip and palate are at risk for psychological problems. Difficulties in mother–child interactions may be relevant, and could be affected by the timing of lip repair.
Method:  We assessed cognitive development, behaviour problems, and attachment in 94 infants with cleft lip (with and without cleft palate) and 96 non-affected control infants at 18 months; mother–infant interactions were assessed at two, six and 12 months. Index infants received either 'early', neonatal, lip repair, or 'late' repair (3–4 months).
Results:  Index infants did not differ from controls on measures of behaviour problems or attachment, regardless of timing of lip repair; however, infants having late lip repair performed worse on the Bayley Scales of Mental Development; the cognitive development of early repair infants was not impaired. Difficulties in early mother–infant interactions mediated the effects of late lip repair on infant cognitive outcome.
Conclusions:  Early interaction difficulties between mothers and infants having late repair of cleft lip are associated with poor cognitive functioning at 18 months. Interventions to facilitate mother–infant interactions prior to surgical lip repair should be explored.     

Ursodeoxycholic acid treatment in preterm infants: a pilot study for the prevention of cholestasis associated with total parenteral nutrition

In a prospective, double-blind, placebo-controlled trial, the efficacy and safety of ursodeoxycholic acid (UDCA) was evaluated in preterm infants, in terms of its potential impact on fat absorption, advancement of enteral feeding, development of cholestasis, growth, nutritional status, and metabolic status. Although fecal fat excretion slightly decreased and achievement of full enteral feeding was earlier in the UDCA group, these differences were not significant. Interestingly, whereas serum gamma-glutamyl transferase activity increased during the parenteral nutrition period in the placebo group, we observed a constant and significant decrease in the UDCA group. This observation warrants further investigation to determine the utility of prophylactic UDCA in preventing cholestasis in infants with prolonged parenteral nutrition.