Patient I. This baby girl was born at 29 weeks' gestation and weighed 670 gm. At four. days of age, because of frequent episodes of apnea and bradycardia, she was started on mechanical ventilation. Early signs of bronchopulmonary dysplasia were noted on the sixteenth day of life and she became respirator dependent for the remainder of her life. DilutedEnfamil feedings were initiated at two days of age and progressively advanced to full-strength formula over a period of two weeks; however, a caloric intake higher than 70 calories/kg/ day was never attained. On the nineteenth day the.infant developed necrotizing enterocolitis and was started on intravenous alimentation. Four days later a perforatitn occurred and a 6 cm segment.of necrotic distM ileum was resected; an ileo.stomy .was constructed. Multiple attempts to re-initiate feedings postoperatively were unsuccessful and intravenous alimentation was contifiued. On the fifty-eighth day the infant was noticed to be markedly jaundiced. The total serum bilirubin value was 28.2 mg/dl (direct 14.4 mg/dl) with SGOT 147 IU, SGPT 67 IU, and alkaline phosphatase 122 ILl. Metabolic disorders, hemolytic processes, and bacterial and viral infections were excluded as possible causes of jaundice. Intravenous alimentation solutions thought to be related to the liver disease were discontinued on the sixty-second day of life. One week later multiple fractured ribs were noted on a routine chest roentgenogram (Fig. 1). Further radiographic studies