Comparison of Smoflipid to Soy-based Lipid Reduction for Cholestasis Prevention in Surgical Neonates

Inclusion Criteria: Neonates with anticipated need for parenteral nutrition (based on primary physicians opinion) for greater than or equal to four weeks and one of the following diagnoses: * Anatomic: Neonate with intestinal atresia, omphalocele, gastroschisis, or volvulus with or without intestinal resection. * Ischemic/perforation: Neonates with spontaneous intestinal perforation or necrotizing enterocolitis requiring surgical intervention. Exclusion Criteria: * Current weight less than 750 grams * AST or ALT greater than 5 times the upper limit of normal within 2 weeks of enrollment * Direct bilirubin greater than 2 mg/dL on any consecutive measurements 5 - 7 days apart within 2 weeks of enrollment * Severe coagulopathy with INR greater than 95th percentile for age (\>1.7 at less than 5 days of age, \> 1.5 older than five days of age) * Culture confirmed sepsis with positive blood, urine, or CSF culture within 2 weeks of enrollment * Renal failure requiring dialysis * Cyanotic heart disease requiring prostaglandin therapy * Hypertriglyceridemia (greater than 250mg/dL) at time of enrollment