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A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition
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Intravenous lipid emulsions in pediatric patients with intestinal failure

Olivier Goulet1, Cécile Lambe

  • 1Department of Pediatric Gastroenterology, Hepatology and Nutrition, Intestinal Failure Rehabilitation Center, National Reference Centre for Rare Digestive Diseases, APHP Necker-Enfants Malades Hospital, Paris-Descartes University, Paris, France.

Current Opinion in Organ Transplantation
|March 8, 2017
PubMed

Insights

Soybean oil-based lipid emulsions may worsen cholestatic liver disease in infants with intestinal failure. Fish oil-based emulsions or reduced dosages are recommended, avoiding pure soybean oil in total parenteral nutrition.

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Clinical Nutrition

Background:

  • Cholestatic liver disease (CLD) incidence in pediatric intestinal failure (IF) is unclear.
  • Approximately 20% of IF patients develop intestinal failure-associated liver disease (IFALD), requiring transplant or leading to death.
  • Premature infants, short bowel syndrome (SBS) patients, and those with sepsis are at risk for CLD, with intravenous lipid emulsions (ILE) implicated.

Purpose of the Study:

  • To review the role of intravenous lipid emulsions (ILE) in the development of cholestatic liver disease (CLD) in pediatric patients with intestinal failure (IF).
  • To compare the effects of different ILE formulations on CLD and IFALD.
  • To provide recommendations for managing CLD in this vulnerable population.

Main Methods:

  • Review of randomized controlled trials and meta-analyses.
  • Comparison of soybean oil (SO)-based ILE with fish oil (FO)-based ILE.
  • Analysis of lipid composition, including omega-3 fatty acids, vitamin E, and plant sterols.

Main Results:

  • Soybean oil (SO)-based ILE formulations differ significantly from fish oil (FO)-based composite ILEs in oil source and fatty acid composition.
  • These differences in composition, including vitamin E and plant sterols, may influence the development and reversal of CLD.
  • Evidence suggests SO-based ILE may be associated with increased risk or severity of CLD in pediatric IF patients.

Conclusions:

  • Pure SO ILE should be avoided in pediatric patients with developing or established CLD or IFALD.
  • Reducing ILE dosage and/or using new composite FO-based ILE are recommended management strategies.
  • Pure FO ILE (10%) is not suitable as sole IV lipid provision in total parenteral nutrition (TPN) but can be used short-term for rescue therapy.

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