Lipid Emulsion Use in Pediatric Patients Requiring Long‐Term Parenteral Nutrition

Goulet, Olivier; Cai, Wei; Seo, Jeong Meen

doi:10.1002/jpen.1762

Cited by 28 publications

(58 citation statements)

References 97 publications

(340 reference statements)

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“…The high LA and ALA content of pure soybean oil emulsions can induce low blood concentrations of their bioactive LC-PUFA metabolites, especially EPA and DHA, and they may be associated with increased rates of infection and lipid peroxidation, exacerbating oxidative stress [30][31][32]. Compared to treatment with SO-based emulsions, administration of lipid emulsions rich in MCT/LC-PUFAs and low in LA and ALA resulted in similar essential fatty acid content in plasma phospholipids and triacylglycerols of preterm neonates [31].…”

Section: Discussionmentioning

confidence: 99%

Administration of an Intravenous Fat Emulsion Enriched with Medium-Chain Triglyceride/ω-3 Fatty Acids is Beneficial Towards Anti-Inflammatory Related Fatty Acid Profile in Preterm Neonates: A Randomized, Double-Blind Clinical Trial

et al. 2020

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Intravenous administration of pure soybean oil emulsions high in linoleic acid may lead to inflammation and lipid peroxidation in preterm neonates. We aimed to investigate the effects of a medium-chain triglyceride (MCT)/ω-3 polyunsaturated fatty acid (PUFA)-enriched intravenous fat emulsion (IVFE) on plasma fatty acid (FA) profile and serum interleukin-6 (IL-6) in preterm neonates. In this double-blind randomized study, 92 preterm neonates (gestational age < 32 weeks, birth weight < 1500 g) were assigned to receive either MCT/ω-3 PUFA-enriched IVFE (Intervention Group) or soybean oil-based IVFE (Control Group). Levels of FAs were measured at baseline (day 0) and day 15 of parenteral nutrition with gas-chromatography mass-spectrometry. Serum IL-6 was measured with sandwich ELISA in 59 neonates. Plasma FAs changed significantly over time; the MCT/ω-3 PUFA-IVFE group showed higher ω-3 PUFAs (p = 0.031), eicosapentaenoic acid (p = 0.000), and oleic acid (p = 0.003), and lower ω-6/ω-3 PUFAs ratio (p = 0.001) and ω-6 PUFAs (p = 0.023) compared to control group. Linoleic acid was higher in the soybean oil (SO)-based IVFE arm compared to the MCT/ω-3 PUFAs-IVFE arm (p = 0.006). Both fat emulsion types decreased IL-6 compared to baseline, but changes were insignificant between groups. Administration of MCT/ω-3 PUFA-enriched IVFE in preterm neonates is beneficial in changing the FA profile consistent with attenuated inflammatory response.

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Section: Discussionmentioning

confidence: 99%

Administration of an Intravenous Fat Emulsion Enriched with Medium-Chain Triglyceride/ω-3 Fatty Acids is Beneficial Towards Anti-Inflammatory Related Fatty Acid Profile in Preterm Neonates: A Randomized, Double-Blind Clinical Trial

et al. 2020

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“…The ability to deliver nutrients via PN has markedly improved the prognosis of infants and children with intestinal failure; however, long-term administration of PN may be associated with complications such as IFALD. [73][74][75] The article by Goulet et al 76 in the current supplement examines emerging insights regarding the role of lipid emulsions in the management of PN-dependent pediatric patients, with a particular focus on the prevention and treatment of IFALD. Corresponding consensus statements are presented in Table 1 (consensus statements [29][30][31][32][33][34][35][36][37][38].…”

Section: Pediatric Patients Requiring Pnmentioning

confidence: 99%

Summary of Proceedings and Expert Consensus Statements From the International Summit “Lipids in Parenteral Nutrition”

Martindale

Berlana

Boullata

et al. 2020

J Parenter Enteral Nutr

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Background The 2018 Lipids in Parenteral Nutrition summit involved a panel of experts in clinical nutrition, lipid metabolism, and pharmacology, to assess the current state of knowledge and develop expert consensus statements regarding the use of intravenous lipid emulsions in various patient populations and clinical settings. The main purpose of the consensus statements is to assist healthcare professionals by providing practical guidance on common clinical questions related to the provision of lipid emulsions as part of parenteral nutrition (PN). Methods The summit was designed to allow interactive discussion and consensus development. The resulting consensus statements represent the collective opinion of the members of the expert panel, which was informed and supported by scientific evidence and clinical experience. Results The current article summarizes the key discussion topics from the summit and provides a set of consensus statements designed to complement existing evidence‐based guidelines. Lipid emulsions are a major component of PN, serving as a condensed source of energy and essential fatty acids. In addition, lipids modulate a variety of biologic functions, including inflammatory and immune responses, coagulation, and cell signaling. A growing body of evidence suggests that lipid emulsions containing ω‐3 fatty acids from fish oil confer important clinical benefits via suppression of inflammatory mediators and activation of pathways involved in the resolution of inflammation. Conclusions This article provides a set of expert consensus statements to complement formal PN guideline recommendations.

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“…A short-term rescue effort less than 15 days may be considered in patients with progression to severe IFALD based on case report data [ 61 , 62 ]. Further, a Consensus Statement from the International Summit “Lipids in Parenteral Nutrition” held in Miami FL in November 2018, stated that in cholestatic (IFALD) pediatric patients on chronic PN, pure fish oil-based IVLE can be used as rescue therapy in severe IFALD (bilirubin >2 mg/dL) [ 63 ]. Pure fish oil-based ICLE should not be used over a prolonged period of time [ 63 ].…”

Section: Management Approachesmentioning

confidence: 99%

“…Further, a Consensus Statement from the International Summit “Lipids in Parenteral Nutrition” held in Miami FL in November 2018, stated that in cholestatic (IFALD) pediatric patients on chronic PN, pure fish oil-based IVLE can be used as rescue therapy in severe IFALD (bilirubin >2 mg/dL) [ 63 ]. Pure fish oil-based ICLE should not be used over a prolonged period of time [ 63 ]. The use of a composite IVLE that includes fish oil as first line treatment for IFALD is recommended [ 63 ].…”

Section: Management Approachesmentioning

confidence: 99%

Intravenous Lipid Emulsions in the Prevention and Treatment of Liver Disease in Intestinal Failure

Rochling

2021

Nutrients

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The development of intestinal failure-associated liver disease (IFALD) in pediatric and adult patients on parenteral nutrition is usually multifactorial in nature due to nutritional and non-nutritional causes. The role of lipid therapy as a contributing cause is well-established with the pathophysiological pathways now better understood. The review focuses on risk factors for IFALD development, biological effects of lipids, lipid emulsions and the mechanisms of lipid toxicity observed in laboratory animals followed by a synopsis of clinical studies in pediatric and adult patients. The introduction of fish oil-based lipid emulsions that provide partial or complete lipid replacement therapy has resulted in resolution of IFALD that had been associated with soybean oil-based therapy. Based on case reports and cohort studies in pediatric and adult patients who were at risk or developed overt liver disease, we now have more evidence that an early switch to partial or complete fish oil–based lipid therapy should be implemented in order to successfully halt and reverse IFALD.

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Lipid Emulsion Use in Pediatric Patients Requiring Long‐Term Parenteral Nutrition

Cited by 28 publications

References 97 publications

Administration of an Intravenous Fat Emulsion Enriched with Medium-Chain Triglyceride/ω-3 Fatty Acids is Beneficial Towards Anti-Inflammatory Related Fatty Acid Profile in Preterm Neonates: A Randomized, Double-Blind Clinical Trial

Administration of an Intravenous Fat Emulsion Enriched with Medium-Chain Triglyceride/ω-3 Fatty Acids is Beneficial Towards Anti-Inflammatory Related Fatty Acid Profile in Preterm Neonates: A Randomized, Double-Blind Clinical Trial

Summary of Proceedings and Expert Consensus Statements From the International Summit “Lipids in Parenteral Nutrition”

Intravenous Lipid Emulsions in the Prevention and Treatment of Liver Disease in Intestinal Failure

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