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• W4382056980 abstract "Introduction: Lipid emulsions are an important component of pediatric parenteral nutrition (PN). PN-associated cholestasis (PNAC), defined as conjugated bilirubin >2 mg/dL or conjugated bilirubin >20% of the total bilirubin if the total bilirubin is >5 mg/dL, is a major complication of long-term PN use. Intralipid® contains 100% soybean oil and is associated with PNAC due to multiple factors including a high content of omega-6 polyunsaturated fatty acids and phytosterols and relatively low alpha-tocopherol levels; SMOFlipid® contains fish oil which has reduced cholestatic risk factors. The study aim was to determine whether first-line use of SMOFlipid for all hospitalized pediatric patients would reduce the rate of PNAC or have a later onset or faster resolution of PNAC when compared with Intralipid. Methods: This double-center, retrospective cohort study included all hospitalized pediatric patients who received ≥14 days of lipid emulsion therapy (Intralipid or SMOFlipid). Primary outcome measures were incidence of PNAC, and time to develop PNAC and time to resolve it. Secondary outcomes included lipid therapy effect on weight and laboratory parameters. Results: Included in this study were 194 hospitalized pediatric patients; 93 received Intralipid and 101 received SMOFlipid. The incidence rate of developing PNAC in SMOFlipid patients was 10% (10/101), which was comparable to 13% (12/93) in Intralipid patients (P=0.651). The time to develop PNAC after lipid therapy initiation was 19.0±13.0 days in the Intralipid group, and 39.7±24.7 in the SMOFlipid group (P=0.02); 83% (10/12) of Intralipid patients developed PNAC at ≤21 days compared with 20% (2/10) of SMOFlipid patients (P=0.008). The time of PNAC resolution was 21.8±21.3 days in SMOFlipid patients, which was not significantly different compared with 33.0±17.5 days in Intralipid patients (P=0.268). Conclusion: Our study shows that SMOFlipid is associated with a delay in onset of cholestasis in hospitalized pediatric patients receiving SMOFlipid as a first-line intravenous lipid emulsion therapy compared with Intralipid therapy. However, SMOFlipid does not show a statistically significant reduction in the incidence of cholestasis. Based on our study findings, we recommend that neonates expected to be on PN for at least 21 days should be initiated on SMOFlipid therapy to delay PNAC. More studies, ideally randomized control trials, are needed to better evaluate the benefits of using SMOFlipid as a first-line intravenous lipid emulsion therapy for all hospitalized pediatric patients." @default.
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• W4382056980 date "2023-06-27" @default.
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• W4382056980 title "102: A Comparison of First-line Intravenous Lipid Emulsions SMOFlipid Versus Intralipid on Incidence and Time to Resolution of Cholestasis in Hospitalized Pediatric Patients" @default.
• W4382056980 doi "https://doi.org/10.1097/01.tp.0000945864.69697.28" @default.
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