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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
Reduced risk of pulmonary emboli in children treated with long-term parenteral nutrition
Judith Pichler1, Lorenzo Biassoni2, Marina Easty2
1Department of Paediatric Gastroenterology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, United Kingdom; Department of Paediatric and Adolescent Medicine, Medical University Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria.
Insights
Newer intravenous lipid emulsions (ILEs) significantly reduced pulmonary embolism (PE) risk in children receiving parenteral nutrition (PN). Despite this reduction, PE remains a complication requiring ongoing surveillance and management.
Area of Science:
- Pediatric Gastroenterology
- Critical Care Medicine
- Nutritional Support
Background:
- Pulmonary embolism (PE) is a significant complication in pediatric patients receiving parenteral nutrition (PN).
- The introduction of new intravenous lipid emulsions (ILEs) in 2003 offered a potential strategy to mitigate PE risk.
- The study aimed to evaluate the impact of these new ILEs on PE incidence.
Purpose of the Study:
- To compare the incidence of pulmonary embolism (PE) in children before and after the introduction of new intravenous lipid emulsions (ILEs).
- To identify risk factors associated with PE in children undergoing parenteral nutrition (PN).
Main Methods:
- Retrospective review of 327 ventilation-perfusion (V/Q) scintigraphies in 68 children (0.3-15 years) treated with PN from 1993 to 2010.
- Comparison of PE rates per 1000 central venous catheter (CVC) days before and after 2003.
- Multivariate regression analysis to identify risk factors for PE.
Main Results:
- A significant reduction in PE incidence was observed after the introduction of new ILEs (32% vs. 11%, p=0.007).
- PE rate decreased from 0.2/1000 CVC days pre-2003 to 0.05/1000 CVC days post-2003 (p=0.04).
- Higher ILE content, frequent ILE administration (>3 nights/week), and older ILEs were associated with increased PE risk, while new ILEs showed a lower risk (p=0.003).
Conclusions:
- Newer ILE formulations are associated with a substantial decrease in PE incidence in pediatric patients on PN.
- Despite the reduction, PE remains a complication necessitating continued vigilance.
- Recommendations include 12-18 monthly lung perfusion scans and anticoagulation therapy upon PE diagnosis.
Background & Aims:
Pulmonary embolism (PE) is a complication of parenteral nutrition (PN) with a prevalence of 35% in children. In 2003 new intravenous lipid emulsions (ILEs) with MCT, olive and/or fish oil in addition to soybean oil were introduced. The aim was to compare the incidence of PE before and after introduction.
Methods:
327 surveillance ventilation-perfusion (V/Q) scintigraphies from 68 children aged 0.3-15 years, treated with PN from 1993 to 2010, were retrospectively reviewed. Rate of PE/1000 central venous catheter (CVC) days, number of children with PE pre- and post-introduction of ILEs were compared. Multivariate analyses were performed for risk factors.
Results:
Twenty-two (32%) children (19/42 before 2003 and 3/26 after 2003, p = 0.007) had at least one episode of PE. Thirty seven (11%) episodes of PE were detected accounting for a mean of 0.2/1000 CVC days prior to 2003 and 0.05/1000 CVC days after 2003, p = 0.04. Regression analysis indicated that higher content of ILE/infusion (p = 0.045) and frequency of ILE of >3 nights/week were associated with more PE (p = 0.001). New ILEs were associated with lower risk (p = 0.003).
Conclusion:
With a four-fold fall in incidence with new ILE, PE remains a complication. We recommend 12-18 monthly surveillance with lung perfusion scan and anticoagulants if PE is diagnosed.
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