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Published on: September 20, 2019
ESPGHAN Committee on Nutrition Position Paper. Intravenous Lipid Emulsions and Risk of Hepatotoxicity in Infants and
Iva Hojsak1, Virginie Colomb, Christian Braegger
1*University Children's Hospital Zagreb, Zagreb, Croatia †Paris, France ‡University Children's Hospital, Zurich, Switzerland §Department of Paediatrics, University Hospital Motol, Prague, Czech Republic ||Department of Paediatrics, University of Granada, Granada, Spain ¶Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden #Newcastle Neonatal Service, Newcastle Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK **Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia ††Department of Pediatric Gastroenterology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands ‡‡Pediatric Gastroenterology Division, Ospedale Pediatrico Giovanni XXIII, University of Bari, Bari, Italy §§Paris Descartes University, APHP Necker-Enfants Malades Hospital, Paris, France ||||CNRC, Baylor College of Medicine, Houston, TX ¶¶Harlaching Hospital Department of Pediatrics, Munich Municipal Hospitals, Munich, Germany ##Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen ***Pediatric Nutrition Unit, Copenhagen University Hospital, Rigshospitalet, Denmark †††Department of Pediatrics, VU University Medical Center, Amsterdam ‡‡‡Department of Pediatrics, Emma Children's Hospital-AMC, Amsterdam, The Netherlands §§§Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK.
Abstract:
The aim of the present article was to perform a systematic review with meta-analysis of available scientific evidence regarding the role of different intravenous lipid emulsions (ILE) in the pathogenesis of cholestasis and parenteral nutrition-associated liver disease. A systematic review of the literature (up to March 2015) identified 23 randomized controlled trials (RCTs). Of these, 17 were performed in preterm infants or critically ill neonates with a short duration of intervention, 2 in older children with short-term use (following surgery or bone marrow transplantation), 1 in neonates with long-term use, and 3 in infants and children receiving long-term parenteral nutrition (PN). Meta-analysis showed no differences in the rate of cholestasis or bilirubin levels associated with short-term use of different ILEs. Because of high heterogeneity of the long-term studies no meta-analysis could be performed. Available studies found that the use of multicomponent fish oil (FO)-containing ILE compared with pure soya bean oil (SO), ILE-reduced liver enzymes, and bilirubin levels in noncholestatic children on long-term PN and one other RCT found that FO-based ILE-reversed cholestasis in a proportion of patients. The ESPGHAN Committee on Nutrition concludes that there is no evidence of a difference in rates of cholestasis or bilirubin levels between different ILE for short-term use in neonates. The use of multicomponent FO-containing ILE may contribute to a decrease in total bilirubin levels in children with IF on prolonged PN. Well-designed RCTs are, however, lacking and long-term effects have not been determined.
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