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Alternate intravenous lipid emulsion strategies for prevention of intestinal failure associated liver disease in neonates requiring abdominal surgery: A randomized pilot trial.

BACKGROUND: Intestinal failure associated liver disease (IFALD) occurs in up to 50% of neonates treated with prolonged parenteral nutrition. Preventative strategies for IFALD include soybean-oil lipid emulsion (SOLE) minimization and use of mixed-oil intravenous lipid emulsions (ILE). We conducted a pilot study prospectively comparing these two ILE strategies in the prevention of IFALD in neonates who required abdominal surgery.

METHODS: We randomized eligible neonates to SOLE at 1 g/kg/day (SOLE Min) or mixed-oil ILE containing fish oil (MOLE) at 3 g/kg/day. These treatment groups were also compared to historic controls who received SOLE at 2-3 g/kg/day (SOLE Historic). We defined IFALD as a direct bilirubin >2mg/dL on two measurements. Secondary outcomes included laboratory, growth, clinical, and nutritional outcomes.

RESULTS: A total of 24 prospective and 24 historic patients were included. There was no difference in the rate of IFALD. However, there was a difference in the weekly change of direct bilirubin levels (SOLE Historic +0.293 mg/dL/week versus MOLE, p <0.001; SOLE Min +0.242 mg/dL/week versus MOLE, p <0.001). The MOLE group also had a lower direct bilirubin at study completion (SOLE Historic 1.7 ± 1.7 mg/dL; SOLE Min 1.6 ± 1.4 mg/dL; MOLE 0.4 ± 0.4 mg/dL; p = 0.002) and received greater total calories (p = 0.008).

CONCLUSION: The rate of IFALD did not differ when comparing ILE strategies in neonates requiring abdominal surgery. However, the MOLE group maintained significantly lower direct bilirubin levels over time while receiving increased calories. This pilot study highlights the need for further randomized controlled trials comparing these ILE strategies. This article is protected by copyright. All rights reserved.

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