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Ursodeoxycholic Acid and SMOFlipid for Treating Parenteral Nutrition Associated Cholestasis in Infants
Saleh Al-Alaiyan1,2, Weam Elsaidawi3, Amal M Alanazi4
1Pediatrics/Neonatal-Perinatal Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, SAU.
Insights
Ursodeoxycholic acid (UDCA) and SMOFlipid significantly reduced the duration of parenteral nutrition-associated cholestasis (PNAC) in infants. This combination therapy proved effective in both very preterm and near-term infants, improving liver function and bile flow.
Area of Science:
- Neonatal Medicine
- Hepatology
- Clinical Nutrition
Background:
- Parenteral nutrition-associated cholestasis (PNAC) is a common complication in preterm infants requiring prolonged parenteral nutrition (TPN).
- Phytosterols in lipid emulsions are implicated in PNAC pathogenesis due to their hepatotoxicity.
- Ursodeoxycholic acid (UDCA) and SMOFlipid (a novel lipid emulsion low in phytosterols) have shown potential in managing cholestasis.
Purpose of the Study:
- To evaluate the efficacy of UDCA combined with SMOFlipid in preventing and treating PNAC in infants.
- To assess the impact of this combined therapy on cholestasis duration in different gestational age groups.
Main Methods:
- A retrospective cohort study included infants receiving TPN for ≥5 days between 2010-2018.
- Infants treated with UDCA for cholestasis and those receiving SMOFlipid were identified.
- Data collected included neonatal demographics, diagnoses, liver function, medications, and maternal variables.
Main Results:
- The combination of SMOFlipid and UDCA significantly reduced cholestasis duration in both gestational age groups.
- Infants with gestational age ≤32 weeks receiving SMOFlipid had a shorter cholestasis duration (67 days) compared to those without (145 days, p=0.04).
- Infants with gestational age >32 weeks receiving SMOFlipid also showed a reduced cholestasis duration (38.2 days) versus those without (117 days, p=0.02).
Conclusions:
- Combined use of UDCA and SMOFlipid effectively reduces the duration of PNAC in infants.
- This therapeutic approach is beneficial for very low birth weight infants, improving outcomes related to TPN-induced liver dysfunction.
Background:
Parenteral nutrition-associated cholestasis (PNAC) is frequently seen in preterm infants receiving total parenteral nutrition (TPN) for a long duration. The pathogenesis of PNAC is believed to be multifactorial; however, phytosterols are hepatotoxic, resulting in cholestasis. A novel lipid emulsion consisting of a mixture of soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOFlipid) with a low level of phytosterols has been shown to improve cholestasis. Moreover, ursodeoxycholic acid (UDCA) has improved bile flow and normalized liver function tests. This study aimed to determine the effect of UDCA and SMOFlipid in preventing and treating PNAC in infants.
Methods:
We conducted a retrospective cohort study that included all infants who received TPN for at least five days between January 2010 and December 2018, who also received UDCA for the treatment of cholestasis, and infants who developed cholestasis but were not treated with UDCA. In addition, any infants who received SMOFlipid for parenteral nutrition during the same period were included. We recorded multiple variables, including neonatal demographic data, major medical diagnosis, liver function, medications, and maternal variables.
Results:
A total of 58 infants with cholestasis who received UDCA for treatment were identified. The infants were divided into two groups, Group 1 infants had gestational age (GA) of ≤32 weeks, and Group 2 had GA of >32 weeks. We found that combining SMOFlipid with UDCA resulted in a significant reduction in cholestasis duration in both groups. Infants in Group 1 who received SMOFlipid had cholestasis for a mean of 67 ± 57 days, and those who did not receive SMOFlipid had cholestasis for a mean of 145 ± 102 days (p=0.04). Infants in Group 2 who received SMOFlipid had cholestasis for a mean of 38.2 ± 28 days, and those who did not receive SMOFlipid had cholestasis for a mean of 117 ± 119 days (p=0.02).
Conclusions:
According to our results, the use of UDCA and SMOFlipid reduced the duration of parenteral nutrition-associated with cholestasis in very low birth weight infants.
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