Admission underweight linked to adverse outcomes in infants with cholestasis

Infants with cholestasis who were underweight at hospital admission had higher rates of readmission and a combined outcome of liver transplantation or death, according to a five-year retrospective cohort study. The analysis included 696 infants with recorded admission ages of 1–12 months and cholestasis, with admissions occurring from 2019 through 2023. Underweight was defined as a weight-for-age z score below −2. It occurred in 163 infants, or 23.4% of the cohort, and was associated with adverse in-hospital and 18-month outcomes. The study reports an association rather than establishing that underweight caused the worse outcomes.

Among the infants classified as underweight, 47.2% had wasting and 52.8% had stunting, based on the study’s complementary anthropometric assessments. By comparison, 7.3% of infants who were not underweight had wasting and 10.5% had stunting. These results show that a weight-for-age z score of at least −2 did not exclude other anthropometric deficits among the comparison group. The investigators therefore described WAZ-defined underweight separately from the complementary assessments rather than treating the measures as interchangeable. Prematurity, small-for-gestational-age status and a low-intake flag were associated with underweight at admission.

Clinical outcomes were ascertained for 628 infants. Readmission occurred in 42.3% of infants who were underweight, compared with 22.0% of the comparison group. Transplantation or death occurred in 14.1% and 4.9%, respectively, in the two groups. A complete-case Cox regression analysis of the 18-month composite outcome included 593 infants and 183 events. Admission underweight was associated with the composite outcome, with an adjusted hazard ratio of 1.70 and a 95% confidence interval of 1.22–2.37. This estimate represents the association remaining after adjustment for variables included in the model; it does not demonstrate that underweight itself produced the higher event hazard.

Growth measurements added a more qualified result. Among 96 initially underweight infants with paired measurements, mean WAZ increased by 1.58 units. The authors cautioned that this observed improvement was subject to regression to the mean and selective follow-up, and that much of the recorded morbidity was prevalent at admission or had an uncertain onset. The retrospective design further limits the ability to determine when growth deficits developed or to separate the effects of nutritional status from other clinical differences. Taken together, the findings identify admission underweight as a marker associated with greater healthcare use and adverse clinical outcomes, while also showing why a single weight-for-age classification does not capture the full range of anthropometric deficits in infants with cholestasis.

Subject of Research: Association of admission underweight with clinical outcomes in infants with cholestasis

Article Title: Admission weight-for-age defined underweight and 18-month clinical outcomes in infants with cholestasis: a five-year retrospective cohort study

Article References: Li, S., Wei, H., Liu, X., He, F., Zhao, Y., & Wang, L. (2026). Admission weight-for-age defined underweight and 18-month clinical outcomes in infants with cholestasis: a five-year retrospective cohort study. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07883-3

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07883-3

Keywords: infantile cholestasis, underweight, weight-for-age z score, wasting, stunting, hospital readmission, liver transplantation, 18-month outcomes, retrospective cohort, anthropometry, Admission, weight-for-age