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Published on: September 20, 2019
Trends in liver profile and nutrition outcomes in children undergoing intestinal rehabilitation using a mixed lipid
Jessica Wassef1,2, Elizabeth Lipkin1, Patrick Hardigan3
1Salah Foundation Children's Hospital at Broward Health Medical Center, Fort Lauderdale, Florida, USA.
Insights
SMOFlipid (SO,MCT,OO,FO-ILE) use in pediatric intestinal rehabilitation (IR) patients demonstrated improved growth and no new cases of liver disease. This lipid emulsion supports development in children requiring parenteral nutrition (PN).
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Hepatology
Background:
- Pediatric patients on parenteral nutrition (PN) for intestinal rehabilitation (IR) face risks of intestinal failure-associated liver disease (IFALD).
- Close monitoring of nutrition, growth, and liver enzymes is crucial.
- Hepatoprotective lipid injectable emulsions are vital for optimal outcomes.
Purpose of the Study:
- To evaluate liver profile and nutrition outcomes in pediatric IR patients using SMOFlipid (SO,MCT,OO,FO-ILE).
Main Methods:
- Prospective observation of pediatric IR patients using SMOFlipid from 2017-2019.
- Monthly monitoring of liver enzymes (AST, ALT, TB), triene/tetraene ratio (TTR), micronutrients, trace elements, and growth z-scores.
- Comparison of baseline and study-end values.
Main Results:
- 16 pediatric patients were studied for an average of 16.4 months on SMOFlipid.
- Significant reductions in PN duration and calories were observed.
- Growth z-scores improved in younger children; no significant changes in liver enzymes or essential fatty acid deficiency.
- No new IFALD cases occurred.
Conclusions:
- SMOFlipid (SO,MCT,OO,FO-ILE) can be used long-term in pediatric IR patients.
- It supports growth and development while maintaining liver health.
- This lipid emulsion is a safe option for managing IFALD risk.
Background:
Pediatric patients undergoing intestinal rehabilitation (IR) using parenteral nutrition (PN) are at higher risk for intestinal failure-associated liver disease (IFALD). Nutrition support, growth, and liver enzymes must be closely monitored while incorporating hepatoprotective lipid injectable emulsions for optimal patient outcomes.
Objective:
Describe trends of liver profile and nutrition outcomes for pediatric patients undergoing IR using SMOFlipid[SO,MCT,OO,FO-ILE]).
Methods:
After IRB approval, patients undergoing IR using SO,MCT,OO,FO-ILE were observed prospectively from January 1, 2017, through December 1, 2019. The following values were documented monthly: aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TB), triene/tetraene ratio (TTR), micronutrient and trace element levels, z-scores for growth, and nutrition support regimen. Values were compared.
Results:
The group involved 16 pediatric patients for an average of 16.4 months on SO,MCT,OO,FO-ILE. By the end of the study, mean PN hours per day decreased by 34.7%, P < 0.0001. Mean PN calories per kilogram decreased from 60.4 to 48.3, P = 0.004. SO,MCT,OO,FO-ILE calories met the recommended dietary intake goal of 30% at the average 1.6 g/kg. Growth z-scores increased in those <2 YOA , although the body mass index decreased in our >2 YOA cohort. Total nutrition received from PN decreased to 62%: a 32% change, P = 0.001. There were no statistically significant changes in AST or ALT. TB decreased by 67.08%, P <0.05. No essential fatty acid deficiency was reported (TTR < 0.02). There were no changes in micronutrient and trace element deficiencies. There was zero new incidences of IFALD.
Conclusions:
SO,MCT,OO,FO-ILE may be used long term in pediatric patients while promoting growth and development.
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