Breastmilk and medium-chain triglyceride supplementation: Retrospective study on outcomes in biliary atresia infants after Kasai.

OBJECTIVE

To relate post-surgical feeding regimens to growth and surgical outcomes in children with biliary atresia (BA) after hepato-portoenterostomy (Kasai).

METHODS

Retrospectively, all children with BA from Denmark and the Netherlands who underwent Kasai from 2014 to 2022 were included. The effect of breastmilk intake on anthropometry after Kasai was evaluated using jointed modeling of longitudinal and survival data, removing children from the analysis at transplantation. Mixed linear models were used to assess surgical outcomes in relation to breastmilk intake and anthropometry in relation to medium-chain triglycerides (MCT) intake, adjusted for calorie intake.

RESULTS

We included 116 children. After Kasai, breastmilk with MCT supplementation was received in 22% for at least 1 month, 9% for 1 week, and 68% did not receive breastmilk. Those receiving breastmilk after Kasai had stable length-for-age z-score (LAZ) over 12 months whereas LAZ decreased in infants without breastmilk feeding (-0.48; 95% confidence interval [CI] 0.24, 0.72). Infants receiving breastmilk for at least 1 month had lower total bilirubin at 3 months (79 vs. 116 µmol/L, p = 0.028) and a lower incidence of cholangitis compared with infants not receiving breastmilk after Kasai. Of those only receiving formula after Kasai, 4% received <40% MCT, 72% received 40-59% MCT and 24% received ≥60% MCT. LAZ was lower in children with MCT intake <40% than in children with MCT intake ≥40%.

CONCLUSION

Feeding regimens in children with BA after Kasai are related to growth and surgical outcomes. Further studies with infants randomized to receive breast milk and to different MCT levels are needed.