High Medium-chain Triglyceride Nutritional Support in Infants With Biliary Atresia

Study on High Medium-chain Triglyceride Nutritional Support in Infants With Biliary Atresia After Kasai Portoenterostomy

This study is a prospective, single-center, randomized controlled, parallel, and open clinical study.

Medium-chain triglyceride（MCT） remains a key component of supplementation in cholestasis. The limited data point to improved growth in cholestatic infants fed with a ratio of MCT/ long-chain triglyceride (LCT) supplementation of 30% to 70% (MCT/LCT mix). It is important to highlight that MCTs are less efficient fuel sources, as MCTs contain fewer kilocalories per gram than LCTs (8.3 kcal/g MCT vs 9 kcal/g LCT), increase total energy expenditure, and are not a source of essential fatty acids. For this reason, a diet of exclusive MCT lipids (>80%, or lower in severe cholestasis) increases the risk of Essential Fatty Acid Deficiency and may contribute to suboptimal weight gain. Supplementation of the diet with MCT may be offered in the form of both MCT supplementation and MCT-containing formulas. it should be noted that while the practice of enriching the diet with MCT oils in the clinical setting is commonplace, a trial comparing MCT to LCT supplementation has never been performed in pediatric cholestasis. A total of 300 infants with Congenital Biliary Atresia after Kasai Portoenterostomy will be enrolled ( randomly divided 150 in the experimental group and 150 in the control group). To evaluate the efficacy, safety, and tolerance of MCT supplementation with breast milk and formula compared with high MCT formula.

A total of 300 infants < 3 months old with Congenital Biliary Atresia after Kasai Portoenterostomy will be enrolled. Randomized grouping, the patients will be fed with high MCT formula milk with breast milk (or infant formula) or MCT supplementation with breast milk (or infant formula) after the Kasai procedure.

high MCT formula with breast milk（or infant formula）: Patients will be enrolled from 4 to 5 days after the Kasai operation. Daily dose: according to the amount of enteral nutrition, q2h, q3h, or tube feeding.

Patients will be enrolled from 4 to 5 days after the Kasai operation. Daily dose: according to the amount of enteral nutrition, q2h, q3h, or tube feeding.

Alfaré(Nestlé Health Science China, including 39% of MCT) with breast milk (or infant formula). Alfaré can be fed with moderate concentration(3.45 tablespoons of 90ml water - 4 tablespoons of 90ml water), and the total energy can be increased by 7.3-16.8kcal/kg/day.

MCT supplement 1-2g/kg/day combined with breast milk (or infant formula), the total energy can be increased by 7.3-14.6kcal/kg/day.

The patient will be weighed in the recumbent position on an electronic infant scale. Z-scores for weight for age (WAZ) were obtained from the World Health Organization Anthro software and WHO Child Growth Standards.

Z-scores were obtained from the World Health Organization Anthro software and WHO Child Growth Standards.

Z-scores were obtained from the World Health Organization Anthro software and WHO Child Growth Standards.

Z-scores were obtained from the World Health Organization Anthro software and WHO Child Growth Standards.

Z-scores were obtained from the World Health Organization Anthro software and WHO Child Growth Standards.

Z-scores were obtained from the World Health Organization Anthro software and WHO Child Growth Standards.

Z-scores were obtained from the World Health Organization Anthro software and WHO Child Growth Standards.

Z-scores were obtained from the World Health Organization Anthro software and WHO Child Growth Standards.

Z-scores were obtained from the World Health Organization Anthro software and WHO Child Growth Standards.

Z-scores were obtained from the World Health Organization Anthro software and WHO Child Growth Standards.

Z-scores were obtained from the World Health Organization Anthro software and WHO Child Growth Standards.

Z-scores were obtained from the World Health Organization Anthro software and WHO Child Growth Standards.

Inclusion Criteria: Type III biliary atresia hepatojejunostomy； Gestational age at birth ≥ 36 weeks； Infants aged 0-3months； Weight ≥ 2kg when entering the group； Informed consent of family members Exclusion Criteria: There are known immune deficiencies； Severe surgical complications (such as intestinal obstruction, massive bleeding, etc.) -occurred during or within 72 hours after the operation； The child's mother has human immunodeficiency disease, or HBsAg positive, or HCV positive； Complicated with other systemic serious diseases (such as congenital multiple malformations, chromosome abnormalities)