Breastmilk helps babies recover after Kasai surgery, study shows
Supplementing breastmilk with certain fats boosts growth, aids liver
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Children with biliary atresia who undergo standard Kasai surgery to restore bile flow tend to grow better and have healthier livers when they receive breastmilk supplemented with specific fats, rather than supplemented baby formula, a study found.
“Feeding regimens in children with [biliary atresia] after Kasai are related to growth and surgical outcomes,” the researchers wrote. “Outcomes depend on nutritional status before, during, and after transplantation.”
The study, “Breastmilk and medium-chain triglyceride supplementation: Retrospective study on outcomes in biliary atresia infants after Kasai,” was published in the Journal of Pediatric Gastroenterology and Nutrition by a team of researchers in Denmark and the Netherlands.
Biliary atresia is a rare condition characterized by blocked or missing bile ducts, the tubes that carry bile from the liver to the intestine. This can cause bile to accumulate to toxic levels in the liver, causing damage, and leak into the bloodstream, resulting in biliary atresia symptoms such as jaundice (yellowing of the skin and eyes).
Symptoms usually appear within the first few weeks after birth. Without treatment, children develop liver failure, for which a liver transplant is the only therapeutic option. Kasai portoenterostomy, a surgery to restore bile flow, is the first-line treatment for biliary atresia. However, about 70% still need liver transplants in childhood.
Fat key to energy for infants
Because bile helps digest fats and “fat is a major energy source in infants,” biliary atresia “limits energy supply,” the researchers wrote.
Breastmilk contains a type of fat called medium-chain triglycerides (MCTs), which are more easily absorbed. While the amount of MCT varies, “any breastmilk before Kasai improves growth compared with formula only,” the researchers wrote.
However, practices regarding breastmilk and MCT formula supplementation after Kasai differ, and it’s uncertain whether this approach is better for supporting adequate growth after the procedure.
The team retrospectively reviewed data from 79 infants in the Netherlands and 37 in Denmark who underwent Kasai surgery from 2014 to 2022 and were followed for up to one year.
The infants’ median age at surgery was 54 days (nearly 2 months). Before Kasai, most infants (60%) had received breastmilk. After surgery, 22% received breastmilk supplemented with MCTs for at least one month, and 9% received it for one week.
Most (68%) were not breastfed after Kasai surgery, but one-third were breastfed before the procedure.
Among those not receiving breastmilk one month after Kasai, 72% received formula with 40%-59% MCT, 24% received at least 60% MCT, and 4% received less than 40% MCT. All infants in this last group died within six months of Kasai.
Growth was measured using standardized scores. Growth was generally similar between children breastfed with MCT supplementation after Kasai and those on MCT supplementation alone.
However, children who received breastmilk after Kasai surgery maintained stable length for their age over the first year, while those who did not had a decline in length-for-age z-scores. A z-score shows how a child compares to average children of the same age.
Among those not breastfed one month after Kasai, intake of formula containing less than 40% MCT was associated with significantly reduced linear growth compared with higher MCT intake.
Blood levels of bilirubin, a marker of liver damage, decreased in all children but increased again in those not receiving breastmilk from one to three months. Children who received breastmilk had lower bilirubin levels at three months, suggesting their livers were more effective at processing this yellowish waste product, which is normally excreted through bile.
Cholangitis, an inflammation of the bile ducts, occurred less often in children who received breastmilk for at least one month. Hospital stays were shorter for children receiving breastmilk, although those who received it for only one week were more often readmitted.
Children who had received breastmilk before surgery had lower bilirubin levels later and were less likely to need a liver transplant within the first year. Older age at the time of Kasai and cholangitis were associated with poorer early weight gain.
Use of corticosteroids, a type of anti-inflammatory and immunosuppressive medication, increased the odds of clearing jaundice and reduced the need for a liver transplant within one year.
“While these findings support feeding with breastmilk in BA, further studies with infants [randomly assigned] to breastmilk versus MCT formula only and to different MCT levels are needed to elucidate this in full,” the researchers wrote.
