Review Article
Volume 10 Issue 4 - 2021
Use of a Mixed-Oil Lipid Emulsion in Infants with Intestinal Failure Associated Liver Disease who were Receiving a Soybean Oil Emulsion
Oscar Herrera1,2, Catherine Crill1,2,3, Luke Parish1, Ramesh Krishnan2,3 and Michael L Christensen1,2,3*
1Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, Tennessee, USA
2Le Bonheur Children’s Hospital, Memphis, Tennessee, USA
3Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
*Corresponding Author: Michael L Christensen, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Received: March 11, 2021; Published: March 29, 2021




Abstract

Introduction: Parenteral nutrition (PN) is crucial to sustain life and ensure adequate growth in infants with gastrointestinal disease. Soybean-oil injectable lipid emulsion (SO-ILE) as a component of prolonged PN has been associated with intestinal failure-associated liver disease (IFALD). A mixed-oil ILE (MO-ILE) may avoid this problem by providing a more balanced fatty acid profile. The purpose of our study was to examine serum bilirubin to determine if the use of a MO-ILE reverses IFALD in PN-dependent infants who had received SO-ILE.

Methods: This was a single-center retrospective study of infants < 1 year of age who received PN for ≥ 4 weeks and received MO-ILE. The primary outcome was resolution of elevated bilirubin concentration in infants who changed from SO-ILE to MO-ILE.

Results: A total of 16 infants receiving SO-ILE who developed an elevated bilirubin and were switched to MO-ILE were included in the analysis. PN and SO-ILE were initiated at a median of 1 (0 - 64) day of life. IFALD onset was 22 ± 15 d after the initiation of PN. MO-ILE was started a median of 8 days (0 - 145 days) from the onset of IFALD. Fifteen infants had resolution of the IFALD after an average of 57 ± 36 days of MO-ILE. Three of the 15 infants had resolution prior to the initiation of enteral feeds, the remaining 12 infants had resolution after 58 ± 36 days of consistent enteral feedings. The infant who did not have resolution of IFALD died two weeks after starting MO-ILE.

Conclusion: MO-ILE was associated with resolution of elevated bilirubin concentrations although the impact cannot be separated out from the effect of enteral feeding. While this study supports the use of MO-ILE, future studies are needed to determine if MO-ILE initiated at the onset of PN will prevent or lower the incidence of developing of IFALD.

 

Keywords: Lipid Emulsions; Liver Disease; Infants; Parenteral Nutrition

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Citation: Michael L Christensen., et al. “Use of a Mixed-Oil Lipid Emulsion in Infants with Intestinal Failure Associated Liver Disease who were Receiving a Soybean Oil Emulsion”. EC Paediatrics 10.4 (2021): 14-21.

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