Evaluation of SMOFlipid in Pediatric Intestinal‐Failure Patients and Its Effects on Essential Fatty Acid Levels

Ho, Beatrice E.; Chan, Stacie C.; Faino, Anna; Mortensen, Melissa; Williamson, Nila; Javid, Patrick J.; Horslen, Simon; Wendel, Danielle

doi:10.1002/jpen.1850

Cited by 13 publications

(16 citation statements)

References 19 publications

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“…Mead acid (MA), EPA, hepatic function, TGs, and the triene:tetraene ratio did not change significantly over time. Although retrospective in nature with a small sample size (N = 20), this case series suggests the SO,MCT,OO,FO‐ILE can maintain EFA levels over prolonged periods of time 33 …”

Section: Ile Indicationsmentioning

confidence: 84%

“…One case series in which EFA status was assessed showed that doses <2.5 g/kg/day were associated with a trend toward EFAD, whereas higher doses increased the risk of IFALD 32 . Another case series followed a group of pediatric IF patients receiving SO,MCT,OO,FO‐ILE at a median dose of 2 g/kg/day over 1.5 years 33 . ALA, LA, ARA, and DHA all significantly increased and remained normal within the reference range.…”

Section: Ile Indicationsmentioning

confidence: 99%

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ASPEN lipid injectable emulsion safety recommendations part 2: Neonate and pediatric considerations

et al. 2021

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Lipid injectable emulsions (ILEs) are complex pharmaceutical formulations intended as a source of energy and fatty acids for parenteral nutrition (PN) therapy. Part 1 of this series addressed issues associated with and safety recommendations pertaining to adult ILE use. Part 2 addresses ILE safety in neonatal and pediatric patients. Considerations for ILE use in the neonatal and pediatric populations differ from those of adults. For example, these patients often require higher doses compared with adult counterparts to support growth, development, and daily metabolic needs. ILE is also frequently administered as a separate infusion as opposed to in a total nutrient admixture owing to compatibility and stability issues and limitations to intravenous access in the neonatal and pediatric populations. ILE is the most frequent PN ingredient associated with PN errors occurring in the administration, prescribing, and transcribing processes. Concerns exist with use of in‐line filters and repackaging of commercial products for infusion. ILE use in neonatal and pediatric patients has been associated with both minor and major adverse effects, which most often occur with doses exceeding manufacturer recommendations. Gaps in ILE best practices for neonatal and pediatric patients predispose to errors in the PN use system. This paper describes safe‐use considerations for ILE products available in the United States in neonatal and pediatric patients, including indications, prescribing, order review, preparation, administration, and monitoring. This paper has been approved by the American Society for Parenteral and Enteral Nutrition (ASPEN) Board of Directors.

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Section: Ile Indicationsmentioning

confidence: 84%

Section: Ile Indicationsmentioning

confidence: 99%

ASPEN lipid injectable emulsion safety recommendations part 2: Neonate and pediatric considerations

et al. 2021

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“…This limited ILE dosing in young children raises concerns about providing sufficient energy for growth, often necessitating increased carbohydrate supplementation to ensure adequate energy. Furthermore, the lack of linoleic acid in FO‐ILE has led to fears regarding essential fatty acid deficiency 21 . However, some report that the amount of arachidonic acid should suffice and that the standard interpretation of fatty acid profiles may not be relevant in a state with altered supplementation 22 .…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the lack of linoleic acid in FO-ILE has led to fears regarding essential fatty acid deficiency. 21 However, some report that the amount of arachidonic acid should suffice and that the standard interpretation of fatty acid profiles may not be relevant in a state with altered supplementation. 22 As the concern with essential fatty acid deficiency is poor growth and neurodevelopment, long-term studies with these 26 Many centers have also made considerable strides in decreasing line-related sepsis [27][28][29] and advancing early enteral nutrition, which may also decrease incidence of liver disease and limit the interpretability of observational studies compared with historical controls.…”

Section: Additional Commentsmentioning

confidence: 99%

Current practices in lipid emulsion utilization in the prevention and treatment of intestinal failure–associated liver disease: A survey of pediatric intestinal rehabilitation and transplant centers

Sevilla

King

Alissa

et al. 2022

J Parenter Enteral Nutr

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Background Newer intravenous lipid emulsions (ILEs), such as fish oil–based intravenous lipid emulsions (FO‐ILEs) and soybean oil, medium‐chain triglycerides, olive oil, and fish oil–based intravenous lipid emulsions (SMOF‐ILEs), provide alternatives to soybean oil–based intravenous lipid emulsions (SO‐ILEs). We explored current ILE practice patterns among intestinal rehabilitation and transplant centers. Methods A survey was developed addressing ILE availability, ILE preference in clinical scenarios, and factors influencing ILE choice. This survey was reviewed locally and by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Intestinal Rehabilitation Special Interest Group, the Intestinal Rehabilitation and Transplant Association scientific committee, and the American Society of Parenteral and Enteral Nutrition pediatric intestinal failure section research committee. We recruited providers nationally and internationally from centers with and without intestinal transplant programs. Results We included 34 complete responses, 29 from the United States. Sixteen centers performed intestinal transplants. All centers had access to SMOF‐ILEs, 85% had access to FO‐ILEs, and 91% had access to SO‐ILEs. In new patients, 85% use SMOF‐ILEs as the first choice ILE. In those with new intestinal failure–associated liver disease (IFALD), FO‐ILE was preferred to SMOF‐ILE (56% vs 38%). In those developing IFALD on SMOF‐ILE, 65% switched to FO‐ILE, whereas 24% remained on SMOF‐ILE. Conclusions Centers have routine access to alternative ILEs, and these are quickly replacing SO‐ILEs in all circumstances. Future work should focus on how this shift in practice affects outcomes to provide decision support in specific clinical scenarios.

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“…A recent study found that SMOFlipid improves the lipid panel in patients with intestinal failure. It increases ALA, LA, and docosahexaenoic acid (DHA) [ 12 ]. Another study on pediatric patients receiving home PN showed that SMOFlipid does not change the lipid profile but decreases the serum bilirubin [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

SMOFlipid Impact on Growth and Neonatal Morbidities in Very Preterm Infants

et al. 2022

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The soybean oil, medium-chain triglycerides, olive oil, and fish oil lipid (SMOFlipid) is increasingly being used worldwide without definite evidence of its benefits. We examined the effect of SMOFlipid on growth velocity and neonatal morbidities in very preterm infants. Very preterm infants who received soybean-based lipid emulsion between January 2015 and 2018 were compared with those who received SMOFlipids between 2019 and January 2022 in our neonatal tertiary center. Linear regression analysis was conducted to analyze the association between type of lipid emulsion and growth velocity. Modified log-Poisson regression with generalized linear models and a robust variance estimator (Huber–White) were applied to adjust for potential confounding factors. A total of 858 infants met our inclusion criteria. Of them, 238 (27.7%) received SMOFlipid. SMOFlipid was associated with lower growth velocity between birth and 36-week corrected gestational age compared with intralipid Δ weight z-score (adjusted mean difference (aMD) −0.67; 95% CI −0.69, −0.39). Subgroup analysis indicated that mainly male infants in the SMOFlipid–LE group had a lower Δ weight z-score compared to those in the intralipid group (p < 0.001), with no difference observed in females (p = 0.82). SMOFlipid was associated with a lower rate of bronchopulmonary dysplasia (BPD) (aRR 0.61; 95% CI 0.46, 0.8) and higher rate of late-onset sepsis compared with intralipid (aRR 1.44; 95% CI 1.22–1.69). SMOFlipid was associated with lower growth velocity and BPD but higher rate of late-onset sepsis—it is a double-edged sword.

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Evaluation of SMOFlipid in Pediatric Intestinal‐Failure Patients and Its Effects on Essential Fatty Acid Levels

Cited by 13 publications

References 19 publications

ASPEN lipid injectable emulsion safety recommendations part 2: Neonate and pediatric considerations

ASPEN lipid injectable emulsion safety recommendations part 2: Neonate and pediatric considerations

Current practices in lipid emulsion utilization in the prevention and treatment of intestinal failure–associated liver disease: A survey of pediatric intestinal rehabilitation and transplant centers

SMOFlipid Impact on Growth and Neonatal Morbidities in Very Preterm Infants

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