Use of Intravenous Soybean and Fish Oil Emulsions in Pediatric Intestinal Failure-Associated Liver Disease: A Multicenter Integrated Analysis Report on Extrahepatic Adverse Events.

Abstract

OBJECTIVE:

To compare extrahepatic adverse events during fish oil lipid emulsion (FOLE) or soybean oil lipid emulsion (SOLE) treatment in children with intestinal failure-associated liver disease (IFALD).

STUDY DESIGN:

In this multicenter integrated analysis, bleeding, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), infections, and signs of lipid emulsion intolerance were compared between FOLE recipients (1 g/kg/d) (n = 189) and historical controls who received SOLE (≤3 g/kg/d) (n = 73).

RESULTS:

When compared with SOLE recipients, FOLE recipients had a lower gestational age (30.5 vs 33.0 weeks; P = .0350) and higher baseline direct bilirubin (DB) (5.8 vs 3.0 mg/dL; P < .0001). FOLE recipients had a decreased incidence of bleeding (P < .0001), BPD (P < .001), ROP (P < .0156), bacterial and fungal infections (P < .0001), and lipid intolerance signs (P < .02 for all). Patients with bleeding vs patients without bleeding had higher baseline DB; the ORs for baseline DB (by mg/dL) and treatment (FOLE vs SOLE) were 1.20 (95% CI: 1.10, 1.31; P ≤ .0001) and 0.22 (95% CI: 0.11, 0.46; P ≤ .0001), respectively. In preterm infants, a higher BPD (P < .0001) and ROP incidence (P = .0071) was observed in SOLE recipients vs FOLE recipients.

CONCLUSIONS:

Children with IFALD who received FOLE had fewer extrahepatic adverse events, including a decreased incidence of bleeding, preterm comorbidities, and lipid intolerance signs compared with children with IFALD who received SOLE. TRIAL REGISTRATION CLINICALTRIALS.GOV: NCT00910104 and NCT00738101.

• Authors: Kathleen M Gura, Kara L Calkins, Muralidhar H Premkumar, Mark Puder
• Journal: The Journal of pediatrics (J Pediatr) Vol. 241 Pg. 173-180.e1 (02 2022) ISSN: 1097-6833 [Electronic] United States
• PMID: 34695449 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 Elsevier Inc. All rights reserved.

Chemical References

• Fat Emulsions, Intravenous
• Fish Oils
• Soybean Oil

Topics

• Fat Emulsions, Intravenous (adverse effects, therapeutic use)
• Female
• Fish Oils (adverse effects, therapeutic use)
• Humans
• Infant
• Infant, Newborn
• Intestinal Failure (complications, therapy)
• Liver Diseases (etiology)
• Male
• Parenteral Nutrition (adverse effects, methods)
• Retrospective Studies
• Soybean Oil (adverse effects, therapeutic use)
• Treatment Outcome