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Published on: September 20, 2019
The role of parenteral lipids in the development of advanced intestinal failure-associated liver disease in infants:
Ivan R Diamond1, Nicole T de Silva, George A Tomlinson
1Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada.
Insights
Parenteral lipids and sepsis increase the risk of liver disease in infants. Reducing lipid dosage and improving line care may prevent conjugated hyperbilirubinemia (CB100) in intestinal failure-associated liver disease (IFALD).
Area of Science:
- Pediatric Gastroenterology
- Neonatology
- Hepatology
Background:
- Intestinal failure-associated liver disease (IFALD) is a concern in infants receiving parenteral nutrition (PN).
- The role of parenteral lipids, particularly omega-6 (ω-6) fatty acids, in IFALD development is under investigation.
- Identifying risk factors for elevated conjugated bilirubin (CB100) is crucial for preventing liver failure.
Purpose of the Study:
- To examine the role of parenteral lipids in the development of serum conjugated bilirubin >100 µmol/L (CB100) in infants.
- To identify predictors of CB100 in infants undergoing abdominal surgery and receiving PN.
Main Methods:
- Prospective data collection from infants undergoing abdominal surgery between 2003 and 2004.
- Univariate and backward stepwise multiple variable logistic regression analyses were used to predict CB100.
- Predictors included patient demographics, surgical factors, enteral feeding, septic episodes, and PN composition and duration.
Main Results:
- Of 152 infants receiving PN, 22 developed CB100.
- Septic episodes (OR, 3.23) and days of maximal lipid intake >2.5 g/kg/d (OR, 1.04) were significant predictors of CB100.
- Prolonged maximal lipid exposure (60 days) increased the odds of advanced IFALD tenfold.
Conclusions:
- Parenteral lipid administration and septic events play a significant role in CB100 development in IFALD.
- Strategies to prevent CB100 include meticulous line care, minimizing maximal lipid doses, and considering alternative lipid formulations like omega-3 (ω-3) fatty acids.
- CB100 serves as a marker for subsequent liver failure in IFALD, highlighting the need for preventative measures.
Background:
Given the recent interest in the role of ω-6 lipids in the development of intestinal failure-associated liver disease (IFALD), the authors sought to examine the role of parenteral lipids in the development of a serum conjugated bilirubin >100 µmol/L (5.9 mg/dL; CB100) in infants.
Method:
Between 2003 and 2004, data were collected prospectively on infants undergoing an abdominal surgical procedure. Univariate logistic regression models for the prediction of CB100 by 1 year postoperatively were developed. Predictors significant at the 0.2 level on univariate analysis were entered into a backward stepwise multiple variable logistic regression.
Results:
Of 152 infants who received parenteral nutrition (PN) postoperatively, 22 developed CB100. Predictors that met criteria for consideration in the multiple-variable model were age, weight, small bowel length, presence of a stoma, proportion of enteral feeds postoperatively, septic episodes, days of maximal PN amino acid (>2.5 g/kg/d), days of maximal lipid (>2.5 g/kg/d), and PN duration. The final model included septic episodes (odds ratio, 3.23; 95% confidence interval, 1.8-5.9) and days of lipid >2.5 g/kg/d (1.04; 1.003-1.06). At 60 days of maximal lipid, the odds of advanced IFALD were increased 10-fold.
Conclusions:
This model suggests a key role of parenteral lipids and septic events in the development of CB100 from IFALD. These data may provide targets, such as careful line care, reduction in maximal lipid dose, or alternate lipids such as ω-3 fatty acids, to prevent CB100, an identified marker of subsequent liver failure from IFALD.
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