Mixed Oil–Based Lipid Emulsions vs Soybean Oil–Based Lipid Emulsions on Incidence and Severity of Intestinal Failure–Associated Liver Disease in a Neonatal Intensive Care Unit

Abstract

Background Neonates requiring long‐term parenteral nutrition (PN) are at risk for developing intestinal failure–associated liver disease (IFALD). The purpose of this study was to compare the incidence and severity of IFALD in a highly surgical neonatal population receiving mixed oil–based lipid emulsions (MOLEs) vs soybean oil–based lipid emulsions (SOLEs) for long‐term PN. Methods This retrospective cohort study evaluated patients admitted to a neonatal intensive care nursery that received PN for ≥14 days. Patients were separated into 2 cohorts; those who received SOLE and those who received MOLE. The primary outcome of this study was the occurrence of IFALD. Secondary outcomes included time to IFALD, peak bilirubin level during therapy, incidence of hypertriglyceridemia, bronchopulmonary dysplasia, and retinopathy of prematurity. Results A total of 107 patients were included in the study, IFALD occurred in 44.8% of patients receiving SOLE compared with 30% of patients receiving MOLE (relative risk, 0.67; 95% CI, 0.39–1.15). In the multivariable analysis, adjusting for the known confounders (prematurity, necrotizing enterocolitis, presence of ostomy, and duration of PN and lipids), the type of lipids was not a significant predictor for development of IFALD. Duration of PN and duration of lipids were determined to be significant risk factors for IFALD, regardless of type of lipid emulsion (odds ratio, 1.03; 95% CI, 1.01–1.05). Conclusions Use of MOLE resulted in no significant difference in the outcomes studied when compared with SOLE. Duration of PN and duration of lipids were significant risk factors for development of IFALD.

Impact of Parenteral Lipid Emulsion Components on Cholestatic Liver Disease in Neonates

“…Interestingly, a recent study by Ferguson el al. looked at 107 patients in a retrospective cohort and found that 44.8% with intestinal failure developed PNAC while receiving SO-LE and only 30% of patients receiving MO-LE [ 68 ]. In their multivariate analysis they found that after adjustment for cofounding factors, the improved performance of MO-LE could not be attributed to the lipid emulsion.…”

IFALD in children: What's new? A narrative review

“…Whereas IFALD was initially considered as a PN complication, an increasing number of evidence suggests that liver disease is not solely due to PN administration but strongly related to IF factors ( 13 ). In addition to the components of PN, prematurity, history of multiple surgical procedures, recurrent sepsis, and the lack of enteral feeding are further known risk factors for the development of IFALD ( 14 ) ( Figure 1 ).…”

“…Intravenous lipid emulsions, particularly when administered at high dose and based on soybean or safflower oil, are implicated in IFALD development ( 3 , 20 ). PN mode of administration and its duration also play a role ( 14 ). Although many risk factors are known, the identification of patients at heightened risk for IFALD progression still poses a considerable challenge due to possible evolution to liver cirrhosis of patients with normal liver enzymes and bilirubin values ( 21 ).…”

“…It is known that SO-LEs, particularly when administered at high doses, are a risk factor for IFALD. This is due to their high content of ω-6 fatty acids and phytosterols ( 14 ). For this reason, its dose has been reduced from ~3 to 1 g/kg/day slowing IFALD progression and ensuring growth and adequate lipid intake.…”

“…Later, MO-LEs have been introduced in clinical practice to prevent and treat IFALD. They contain a more balanced ratio of ω-6 to ω-3 fatty acids providing immunomodulatory benefits and might reduce the incidence of cholestasis, hepatic steatosis, and IFALD ( 14 , 18 ). In 2021, Ferguson et al ( 14 ) evaluated the incidence and severity of IFALD in a highly surgical neonatal population who received MO-LEs and SO-LEs and required long-term PN.…”