Development of Parenteral Nutrition-Associated Liver Disease and Other Adverse Effects in Neonates Receiving SMOFlipid or Intralipid.

Abstract

BACKGROUND:

Intravenous lipid emulsions (ILEs) are a risk factor for parenteral nutrition-associated liver disease (PNALD) in the neonatal population. Current literature supports the use of SMOFlipid (4-oil ILE), a fish oil-containing lipid emulsion, for the reversal of PNALD. However, there is little information about the use of 4-oil ILEs for preventing PNALD. The purpose of this study is to examine the safety of a 4-oil ILE in neonates and its effectiveness in preventing PNALD among neonates compared with Intralipid (a soybean-oil, SO-ILE).

METHODS:

This is an observational, cohort, comparative safety study, conducted in a level III neonatal intensive care unit. Participants include neonates who received a 4-oil ILE in their parenteral nutrition (PN) formula, who were matched with historical data of patients who received an SO-ILE, in a 1:3 fashion (4-oil ILE:SO-ILE). The primary outcome of this study is the presence of PNALD (defined as direct bilirubin > 2 mg/dL) after initiation of PN.

RESULTS:

A total of 1332 participants (333 4-oil ILE vs 999 SO-ILE) were included in the data analysis, and PNALD was found to occur in 1.8% of patients in the 4-oil ILE group and 3.6% of patients in the SO-ILE group (Relative risk (RR) 0.5; 95% CI, 0.21-1.18).

CONCLUSION:

The decrease in the incidence of PNALD among the 4-oil ILE group compared with the SO-ILE group indicates a 4-oil ILE may have a hepatoprotective effect.

• Authors: Lindsey Stramara, Lela Hernandez, Barry T Bloom, Christopher Durham
• Journal: JPEN. Journal of parenteral and enteral nutrition (JPEN J Parenter Enteral Nutr) Vol. 44 Issue 8 Pg. 1530-1534 (11 2020) ISSN: 1941-2444 [Electronic] United States
• PMID: 32027047 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2020 American Society for Parenteral and Enteral Nutrition.

Chemical References

• Emulsions
• Fat Emulsions, Intravenous
• Fish Oils
• Olive Oil
• Phospholipids
• Triglycerides
• soybean oil, phospholipid emulsion
• Soybean Oil
• SMOFlipid

Topics

• Emulsions
• Fat Emulsions, Intravenous (adverse effects)
• Fish Oils (adverse effects)
• Humans
• Infant, Newborn
• Liver Diseases (etiology)
• Olive Oil
• Parenteral Nutrition (adverse effects)
• Phospholipids
• Soybean Oil (adverse effects)
• Triglycerides