Neonatal cholestasis is characterized by a conjugated hyperbilirubinemia and indicates the presence of a severe underlying condition. A population-based retrospective case-control study, conducted by Teng J et al, determined the outcomes associated with neonatal cholestasis in preterm infants. 

The study included preterm infants, gestational age <30 weeks, surviving for 28 days. Cholestasis was measured as conjugated bilirubin ≥30 μmol/L exceeding 20% of total level at least twice and graded as high if exceeding 100 μmol/L. 

The outcome divulged that the incidence rate of cholestasis in the cohort was 14.8%, with increasing rates in lower gestational weeks. Perinatal factors related to cholestasis were pre-eclampsia and being born small for gestational age. It was observed that infants with cholestasis had three times more bronchopulmonary dysplasia and eight times more retinopathy of prematurity. Mortality was found to be more in cholestatic infants (had high-grade cholestasis) as compared to controls (13.5% versus 2.7%). However, none of the surviving infants developed chronic liver disease by 10 years of age.

Based on these findings, it can be concluded that cholestasis is a frequently encountered problem in very preterm infants and is associated with disease severity and adverse outcome. Cholestasis can manifest as an independent risk factor for bronchopulmonary dysplasia and retinopathy of prematurity while its more severe form is linked with increased mortality. However, it might not be associated with chronic liver disease in late childhood.

Source: Teng J, Bohlin K, Nemeth A, Fischler B. Cholestasis after very preterm birth was associated with adverse neonatal outcomes but no significant long-term liver disease: A population-based study [published online ahead of print, 2020 Jun 11]. Acta Paediatr. 2020;10.1111/apa.15408.