A 26-week extremely low birth weight neonate has been on total parenteral nutrition for 4 weeks. Direct bilirubin is 4.5 mg/dL with elevated gamma-glutamyl transferase. Abdominal ultrasound shows a normal gallbladder. What is the most likely cause of this cholestasis?
- A TPN-associated cholestasis ✓
- B Biliary atresia
- C Neonatal hepatitis
- D Cystic fibrosis
Correct answer: A. TPN-associated cholestasis
Explanation
Prolonged TPN in extremely low birth weight infants is a major cause of cholestasis due to lack of enteral feeding, which fails to stimulate bile flow. Biliary atresia presents with acholic stools and an absent or abnormal gallbladder on ultrasound.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.