One‐year Experience With Composite Intravenous Lipid Emulsion in Children on Home Parenteral Nutrition

Abstract

Background: Composite lipid emulsion (CLE) composed of soybean oil, medium-chain triglycerides, olive oil, and fish oil is approved in the US for parenterally fed adults. For stable children discharged on home parenteral nutrition (HPN) without cholestasis (direct bilirubin > 2.0 mg/dL), CLE has theoretical benefits over soybean-based intravenous lipid emulsion due to reduced phytosterol exposure with higher calorie support to permit reduced glucose infusion rates (GIRs), omega-3 supplementation, and supplemental α-tocopherol. Methods: In this prospective, single-center open-label research study, safety and efficacy outcomes were evaluated in patients on HPN younger than 18 years treated with CLE at 1 to 3 g · kg−1 · day−1 over 12 months. The primary outcome was change in anthropometrics and GIRs compared with baseline. Secondary outcomes were changes in fatty acid profiles and liver function and enzyme tests compared with baseline. Results: Fifty-seven subjects were treated with a median age of 7 years. The diagnosis was short bowel syndrome in 72%. Change in practice was associated with a decrease in mean GIRs from 17 to 14 mg · kg−1 · h−1 at 4 to 6 months postbaseline and beyond with a coincidental decline in mean arachidonic acid and stable growth parameters. No significant adverse events were noted. Conclusions: CLE was safe and well-tolerated in stable children on HPN at 1 year, but further studies are needed in this population to appreciate long-term outcomes.

Nutritional and medical approaches to intestinal failure

“…A prospective single-center study of 57 children with IF on HPN at Boston Children's Hospital showed a significant decrease in baseline glucose infusion rate at 4 to 6 months of treatment, compared with glucose infusion rate before CLE initiation. Despite this reduction, there were no statistical differences in height, weight, or BMI nor were there differences in serum total and direct bilirubin or in the development of EFA deficiency [11].…”

Composite lipid emulsion use and essential fatty acid deficiency in pediatric patients with intestinal failure with high parenteral nutrition dependence: A retrospective cohort study

“…[45][46][47]58 The results of the current study are similar to other published reports that showed no biological or clinical evidence of EFAD in patients when lipid was provided at conventional dosing. [59][60][61] Additionally, patients did not have biochemical evidence of cholestatic liver disease despite the higher dose of MO ILEs for a prolonged period.…”