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A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition
Published on: September 20, 2019
Impact of parenteral fat composition on cholestasis in preterm infants
Jonas Teng1, Henrik Arnell, Kajsa Bohlin
1Pediatric Unit, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
Insights
Replacing soy-based lipid emulsions with olive oil-based ones did not significantly reduce parenteral nutrition-associated liver disease (PNALD) in preterm infants. Olive oil-based emulsions appear to carry an equal or slightly decreased risk for PNALD development.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Parenteral nutrition-associated liver disease (PNALD) is a significant concern in neonatal intensive care units.
- Parenteral lipid emulsion (PLE) composition is suspected to influence PNALD pathogenesis.
- Investigating alternative PLE formulations is crucial for improving infant outcomes.
Purpose of the Study:
- To evaluate the impact of switching from soy-based to olive oil-based PLE on PNALD incidence and outcomes.
- To compare PNALD rates in preterm infants before and after the change in PLE formulation.
- To assess the safety and efficacy of olive oil-based PLE in a vulnerable neonatal population.
Main Methods:
- A population-based study included preterm infants (gestational age <30 weeks) in Stockholm County.
- PNALD was defined by specific criteria for conjugated serum bilirubin levels.
- Two distinct 2-year periods were compared: one using soy-based PLE and the other using olive oil-based PLE.
Main Results:
- The incidence of PNALD was similar between the soy-based (14.8%) and olive oil-based (12.7%) PLE periods (P = 0.52).
- Infants in the olive oil group with PNALD had more risk factors, including lower gestational age and longer parenteral nutrition duration.
- Soy oil-based PLE treatment emerged as an independent risk factor for PNALD in logistic regression analysis.
Conclusions:
- The population-based incidence of PNALD in preterm infants with gestational age <30 weeks is approximately 1 in 7.
- Switching from soy oil to olive oil-based PLE did not lead to a significant reduction in PNALD incidence.
- Olive oil-based PLE demonstrates an equal or slightly decreased risk for PNALD development compared to soy oil-based PLE.
Objectives:
Parenteral nutrition-associated liver disease (PNALD) is frequently detected in neonatal intensive care units. Parenteral lipid emulsion (PLE) content has been implicated in its pathogenesis. We aimed to study the effect on incidence and outcome of PNALD by replacing soy-based PLE with olive oil-based PLE in a population-based group of preterm infants.
Methods:
All infants in Stockholm County with gestational age (GA) <30 weeks were included (n = 615). Infants who died before 28 days of age or were referred to or from other regions were excluded (n = 97). PNALD was defined as conjugated serum bilirubin ≥ 30 μmol/L and exceeding 20% of the total fraction on at least 2 occasions. Two different 2-year time periods were compared: before (SOY period) and after (OLIVE period) switching PLE. For each PNALD case, 2 GA-matched controls were randomly identified.
Results:
PNALD incidence was 14.8% (37/250) in the SOY period and 12.7% (34/268) in the OLIVE period (P = 0.52). The OLIVE infants with PNALD had more risk factors, such as lower GA and longer periods of parenteral nutrition, for developing PNALD than the SOY infants. Nevertheless, treatment during the SOY period was an independent risk factor for PNALD in logistic regression analysis.
Conclusions:
Population-based incidence of PNALD is 1 of 7 in preterm infants with GA < 30 weeks. Changing from soy oil to olive oil-based PLE did not decrease the incidence of PNALD significantly. Olive oil-based PLE carries an equal or slightly decreased risk to develop PNALD compared with soy oil-based PLE.
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