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A comparison of lipid minimization strategies in children with intestinal failure
Jessica Gonzalez-Hernandez1, Purvi Prajapati2, Gerald Ogola2
1Department of Surgery, Baylor University Medical Center, Dallas, TX.
Insights
Lipid minimization using Intralipid (IL) or Omegaven® showed similar success in treating liver disease in children with intestinal failure (IF) and intestinal failure-associated liver disease (IFALD). Both treatments normalized direct bilirubin without affecting nutritional status or growth.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Parenteral Nutrition
Background:
- Intestinal failure (IF) often necessitates parenteral nutrition (PN), increasing the risk of intestinal failure-associated liver disease (IFALD).
- IFALD is a serious complication in children receiving long-term PN.
- Lipid formulations are a key consideration in managing IFALD.
Purpose of the Study:
- To compare the efficacy of lipid minimization with Intralipid (IL) versus Omegaven® in children with IF and IFALD.
- To assess the impact on direct bilirubin levels, liver function, and growth.
Main Methods:
- Retrospective review of children with IF and IFALD (direct bilirubin >2 mg/dL) receiving PN.
- Comparison of clinical characteristics, nutritional intake, and laboratory values between groups treated with reduced IL or Omegaven®.
- Study level of evidence: III.
Main Results:
- 16 children were analyzed (8 IL, 8 Omegaven®).
- Both groups showed similar demographics, small bowel length, and PN intake.
- No significant differences were observed in the time to normalize direct bilirubin (113 days for IL vs. 124 days for Omegaven®), liver function markers, or growth trajectories.
Conclusions:
- Lipid minimization with either IL or Omegaven® is equally effective in normalizing direct bilirubin in children with IFALD.
- Neither approach demonstrated significant differences in nutritional status or growth outcomes.
- This suggests flexibility in lipid formulation choice for managing IFALD in this population.
Purpose:
The purpose of this study was to compare outcomes of lipid minimization with either Intralipid (IL) or Omegaven® in children with intestinal failure (IF) who developed intestinal failure-associated liver disease (IFALD) while receiving parenteral nutrition (PN).
Methods:
A retrospective review of children with IF requiring PN who developed IFALD (direct bilirubin >2 mg/dL) while receiving IL (2009-2016) was performed. Clinical characteristics, nutritional, and laboratory values were compared between children treated with reduced IL or Omegaven®.
Results:
16 children were reviewed (8 treated with IL and 8 treated with Omegaven® at a median dose of 1g/kg/d). Both groups had similar demographics, small bowel length, and parenteral nutritional intake during the study (82.9±27.1 kcal/kg/d vs. 75.9±16.5 kcal/kg/d, p=0.54). The mean direct bilirubin (DBili) prior to initiating treatment was 7.8±4.3 mg/dL and 7.5±3.5 mg/dL (p=0.87) in the IL and Omegaven® groups, respectively. The IL group took a median of 113 days to achieve a DBili <0.5 mg/dL compared to 124 days in the Omegaven® group (p=0.49). There were no differences in markers of liver function or growth trajectories among groups.
Conclusions:
Lipid minimization with either IL or Omegaven® has similar success in achieving a normal DBili in children with IF and IFALD without major differences in nutritional status or growth.
Type Of Study:
Treatment Study LEVEL OF EVIDENCE: III.
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