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

Stramara, Lindsey; Hernandez, L Oliva; Bloom, Barry T.; Durham, Christopher A.

doi:10.1002/jpen.1774

Cited by 10 publications

(12 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Over the past decade, several studies have compared MOLE to SOLE and FOLE. In children with IF from surgical and nonsurgical diagnoses receiving PN for ≥7 days, MOLE demonstrated equivalent or slightly improved serum direct bilirubin compared with SOLE 24,33–38 . In one study, patients receiving MOLE had lower incidence of cholestasis than those receiving SOLE but only received PN for 10 days.…”

Section: Discussionmentioning

confidence: 99%

Incidence and development of cholestasis in surgical neonates receiving an intravenous mixed‐oil lipid emulsion

Anez‐Bustillos

Mitchell

et al. 2022

J Parenter Enteral Nutr

View full text Add to dashboard Cite

Background Intestinal failure–associated liver disease (IFALD), initially manifesting as cholestasis, is a complication in neonates receiving parenteral nutrition (PN). Soybean oil lipid emulsion (SOLE), though implicated in IFALD, was the only US Food and Drug Administration (FDA)–approved initial intravenous lipid emulsion (ILE) for infants and children in the United States. A mixed‐oil lipid emulsion (MOLE) gained popularity in patients at risk for IFALD and was recently FDA approved as an initial ILE in children. Given the presence of soybean oil in MOLE, we hypothesized that MOLE would not be effective at preventing cholestasis in surgical neonates. Methods Neonates with gastrointestinal surgical conditions necessitating PN for ≥14 days and receiving MOLE (SMOFlipid) from July 2016 to July 2019 were analyzed retrospectively. Unpaired and pair‐matched historical surgical neonates treated with SOLE (Intralipid) served as controls. The primary outcome measure was development of cholestasis (direct bilirubin ≥2 mg/dl). Results Overall, 63% (10 of 16) of MOLE patients and 22% (30 of 136) of SOLE patients developed cholestasis after ≥14 days of therapy (P = 0.005). The latency to developing cholestasis was significantly shorter in MOLE patients compared with SOLE patients. Conclusion In surgical neonates, MOLE may not prevent cholestasis and should not be considered hepatoprotective. Regardless of ILE source, all surgical neonates should be closely monitored for development of IFALD. To date, there is still no ILE able to prevent IFALD.

show abstract

Section: Discussionmentioning

confidence: 99%

Incidence and development of cholestasis in surgical neonates receiving an intravenous mixed‐oil lipid emulsion

Anez‐Bustillos

Mitchell

et al. 2022

J Parenter Enteral Nutr

View full text Add to dashboard Cite

show abstract

“…In this setting, Stramara and colleagues found no significant difference in cholestasis in patients treated with SO, MCT, OO, FO-ILE vs SO-ILE in a retrospective review with an average PN length of 5.9-6.6 days, although the range of treatment courses did exceed this 4-week period. 30 Although there is possibly evidence to support the long-term use of SO, MCT, OO, FO-ILE in select populations, there is scant evidence to support its use over SO-ILE in the short-term. Several concerns with SO, MCT, OO, FO-ILEs have been raised.…”

Section: Discussionmentioning

confidence: 99%

Patterns of lipid‐injectable emulsion use in neonatal intensive care units across the United States: A multi‐institution survey

Huff

Nayak

Ahmad

et al. 2022

J Parenter Enteral Nutr

View full text Add to dashboard Cite

Background Lipid‐injectable emulsions (ILEs) are a necessity for neonates dependent on parenteral nutrition (PN). In this manuscript, we describe the patterns of ILE use in neonatal intensive care units (NICUs) in the United States (US). Methods An electronic survey was sent to 488 NICUs across the US between December 2020 and March 2021. Survey fields included availability and utilization of various ILE in neonates. Results The response rate was 22% (107 out of 488). Soybean oil ILE (SO‐ILE) and soybean oil, medium‐chain triglycerides, olive oil, fish oil ILE (SO, MCT, OO, FO‐ILE) had similar availability (87% vs 86%, respectively), and SO, MCT, OO, FO‐ILE was more commonly used (SO‐ILE, 71% vs SO, MCT, OO, FO‐ILE, 86%). Fish oil‐ILE (FO‐ILE) was used by 55% of centers. SO‐ILE was most frequently used with PN and needs <4 weeks without cholestasis (79%). The most common reason for SO, MCT, OO, FO‐ILE use was cholestasis (71%). ILE minimization was used by 28% of SO‐ILE and 22% of SO, MCT, OO, FO‐ILE users; 95% of these centers restrict SO, MCT, OO, FO‐ILE to doses ≤2 g/kg/day. Twenty‐two percent of centers started FO‐ILE at direct bilirubin of >5 mg/dl. Conclusion The results of this survey reveal significant variability in ILE usage across the US. Lipid minimization with SO, MCT, OO, FO‐ILE and initiation of FO‐ILE for cholestasis at higher bilirubin thresholds are prevalent. Such reports are crucial for a better understanding of ILE use in the NICU and in future ILE development.

show abstract

“…Fat emulsion intake cannot be completely eliminated -lipids are not only a source of energy, but also provide fatty acids necessary for maintaining cell membrane integrity, supporting immune function, and regulating gene expression. Studies show that fish fat emulsions reduce the likelihood of PNALD [17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

“…Lipid intake depends on the patient's underlying disease, energy requirements, body weight and recent weight loss, and the body's metabolic capacity. The dose of 2.5 g lipids/kg body weight/day should not be exceeded [17,19].…”

Section: Discussionmentioning

confidence: 99%

Activity of aminotransferases as a marker of liver injury in home parenteral nutrition patients

Dąbrowska¹,

Zaczek²,

Złotogórska³

et al. 2022

ceh

View full text Add to dashboard Cite

Aim of the study: Parenteral nutrition associated liver disease (PNALD) is a frequently reported complication of long-term parenteral nutrition. Early diagnosis and treatment of PNALD can help prevent end-stage liver disease. The aim of the study was to evaluate the activity of aminotransferases as a marker of liver dysfunction in patients receiving home parenteral nutrition under the care of a reference center. Material and methods: A comprehensive analysis of patients' medical records from a 9-year period (December 2012 -December 2021) was conducted and the following parameters were evaluated: parenteral nutrition mixture composition, total plasma bilirubin, activity of the liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST), standardized time factor prothrombin (international normalized ratio [INR] factor) and serum albumin. The analysis covered 630,537 days of parenteral nutrition. The study included 251 patients (140 women and 111 men) included in the Home Parenteral Nutrition Program. Results: PNALD was diagnosed in 11 parenteral fed patients, which gives the frequency of 8.3%/9 years of treatment. Two deaths were classified as cause of death related to liver disease but not related to PNALD. None of the patients included in the analysis developed end-stage liver failure. Conclusions:The above analysis shows that individual selection of the composition of the mixture for intravenous nutrition significantly reduces the risk of PNALD and may prevent liver failure in this context.

show abstract

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

Cited by 10 publications

References 15 publications

Incidence and development of cholestasis in surgical neonates receiving an intravenous mixed‐oil lipid emulsion

Incidence and development of cholestasis in surgical neonates receiving an intravenous mixed‐oil lipid emulsion

Patterns of lipid‐injectable emulsion use in neonatal intensive care units across the United States: A multi‐institution survey

Activity of aminotransferases as a marker of liver injury in home parenteral nutrition patients

Contact Info

Product

Resources

About