Resolution of parenteral nutrition-associated jaundice on changing from a soybean oil emulsion to a complex mixed-lipid emulsion.

Abstract

BACKGROUND AND OBJECTIVE:

Resolution of parenteral nutrition (PN)-associated jaundice has been reported in children given a reduced dose of intravenous fat using a fish oil-derived lipid emulsion. The aim of the present study was to examine the effect on PN-associated jaundice of changing from a soybean oil-derived lipid to a mixed lipid emulsion derived from soybean, coconut, olive, and fish oils without reducing the total amount of lipid given.

METHODS:

Retrospective cohort comparison examining serum bilirubin during 6 months in children with PN-associated jaundice who changed to SMOFlipid (n=8) or remained on Intralipid (n=9).

RESULTS:

At entry, both groups received most of their energy as PN (SMOFlipid 81.5%, range 65.5-100 vs Intralipid 92.2%, range 60.3-100; P=0.37). After 6 months, both tolerated increased enteral feeding but still received large proportions of their energy as PN (SMOFlipid 68.4%, range 36.6-100 vs Intralipid 50%, range 37.6-76; P=0.15). The median bilirubin at the outset was 143 μmol/L (range 71-275) in the SMOFlipid group and 91 μmol/L (range 78-176) in the Intralipid group. After 6 months, 5 of 8 children in the SMOFlipid and 2 of 9 children in the Intralipid group had total resolution of jaundice. The median bilirubin fell by 99 μmol/L in the SMOFlipid group but increased by 79 μmol/L in the Intralipid group (P=0.02).

CONCLUSIONS:

SMOFlipid may have important protective properties for the liver and may constitute a significant advance in PN formulation. Randomised trials are needed to study the efficacy of SMOFlipid in preventing PN liver disease.

• Authors: Rafeeq Muhammed, Ronald Bremner, Sue Protheroe, Tracey Johnson, Chris Holden, M Stephen Murphy
• Journal: Journal of pediatric gastroenterology and nutrition (J Pediatr Gastroenterol Nutr) Vol. 54 Issue 6 Pg. 797-802 (Jun 2012) ISSN: 1536-4801 [Electronic] United States
• PMID: 22157927 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Dietary Fats
• Fat Emulsions, Intravenous
• Fish Oils
• Olive Oil
• Plant Oils
• Soybean Oil
• Coconut Oil
• Bilirubin

Topics

• Bilirubin (blood)
• Child, Preschool
• Coconut Oil
• Dietary Fats (adverse effects, pharmacology, therapeutic use)
• Fat Emulsions, Intravenous (chemistry)
• Fish Oils (pharmacology, therapeutic use)
• Humans
• Infant
• Jaundice (drug therapy, etiology)
• Liver (drug effects)
• Olive Oil
• Parenteral Nutrition (adverse effects, methods)
• Parenteral Nutrition, Total
• Plant Oils (adverse effects, pharmacology, therapeutic use)
• Retrospective Studies
• Soybean Oil (adverse effects)