Standard Lipid Therapy vs IVFE Minimization for Prevention of PNALD

Inclusion Criteria: * neonates and infants who are at least 28 weeks corrected gestational age at the time of enrollment who are parenteral nutrition (PN) naive * current direct bilirubin \<2 mg/dL * any of the following conditions: * meconium ileus and peritonitis * gastroschisis * omphalocele \>4cm or with liver herniated outside of the abdominal cavity * necrotizing enterocolitis requiring surgical intervention * volvulus * intestinal atresia with \>50% bowel loss Exclusion Criteria: * weight \<1 kg * metabolic pathway defect which is associated with liver dysfunction in the neonatal period, including: hereditary fructose intolerance, galactosemia due to transferase deficiency and neonatal tyrosinemia, and/or disorder of lipid metabolism * hepatic insufficiency as documented by either a biopsy with cirrhosis and/or marked aberration in synthetic function * renal failure * primary or secondary liver disease, regardless of liver function (includes hepatitis) * use of extracorporeal membrane oxygenation (ECMO) * suspected congenital obstruction of the hepatobiliary tree * documented active infection which may be communicable, including infections hepatitis or HIV * previous receipt of choleretic agents * currently receiving phenobarbital or other barbiturates * history of PNAC * direct bilirubin \>=2 mg/dL at time of enrollment * congenital or acquired anomaly which will require major cardiovascular surgery * major congenital or chromosomal anomaly * hypoxic ischemic encep…