Association between multioil intravenous lipid emulsion and cholestasis in infants with gastrointestinal disorders: A...

Infants with gastrointestinal (GI) disorders are at risk for parenteral nutrition-associated cholestasis. A multioil intravenous lipid emulsion (MO ILE) contains less phytosterols and more arachidonic and docosahexaenoic acid (DHA) than 100% soybean oil lipid emulsion (SO ILE). This study compares parenteral nutrition-associated cholestasis, growth, and fatty acids in infants with GI disorders who received MO ILE or SO ILE.

This retrospective cohort study included 48 infants with GI disorders born between 2014 and 2022 who received an intravenous lipid emulsion for ≥14 days. Cholestasis was defined as serum conjugated bilirubin ≥2 mg/dl; growth was assessed by z score changes. Gas chromatography and mass spectrometry was used to measure fatty acid content in the erythrocyte cell membrane.

The incidence of parenteral nutrition-associated cholestasis was similar (MO ILE 30% vs SO ILE 29%, P > 0.99). However, compared with infants who received parenteral nutrition >28 days and SO ILE, infants who received parenteral nutrition >28 days and MO ILE experienced a slower rise in conjugated bilirubin (0.1 ± 0.03 vs 0.26 ± 0.38 mg/dl, P interaction < 0.001). Weight z score decline (discharge to birth) was less in the MO ILE group vs SO ILE group (-1.0 [-2.0, -0.4] vs -0.4 [-0.9, 0], P = 0.04). Although the MO ILE group demonstrated improved DHA status at weeks 1-3 (P < 0.05 for all), arachidonic acid and DHA decreased over time in both groups and there was no difference in the rate of change (P interaction > 0.3 for both).

In infants with GI disorders, MO ILE was associated with improved growth. MO ILE was well tolerated and hepatoprotective in infants who required prolonged parenteral nutrition.