Intestinal failure-associated liver disease and growth pre- and post-transition to a composition lipid emulsion.

OBJECTIVES: Infants with intestinal failure have an increased risk of intestinal failure-associated liver disease (IFALD). Composite intravenous lipid emulsion (ILE) may reduce the risk of cholestasis. The primary outcome was to compare IFALD rates in infants with intestinal failure, between those receiving a composite ILE versus soybean oil ILE. The secondary outcome compared growth between these two groups.

METHODS: At our two tertiary neonatal/pediatric hospitals, we identified all patients (≤1 year old) who received ≥ 6 weeks PN from 2010-2018. Data included liver and growth parameters. IFALD was defined as serum conjugated bilirubin (CB) >33 µmol/L (≥2 mg/dl). Non-parametric tests were used for all comparisons.

RESULTS: Fifty infants (35 composite ILE, 15 soybean oil ILE) were included. Those on composite ILE received PN for longer (10.1 weeks vs. 7.6 weeks; p=0.001) and had higher baseline CB (29 vs. 6.5μmol/L; p=0.001). No differences were found by 6 weeks (14.5 vs. 5μmol/L; p=0.54) and by PN cessation (4 vs. 4μmol/L; p=0.33). The proportion of patients with IFALD decreased from 54% to 20% for composite ILE, while stable given soybean oil ILE (7%). There were no differences in weight, length, or head circumference z-scores (p>0.05).

CONCLUSIONS: In our institutions, over eight years, chronic intestinal failure was rare. Composite ILE was the predominant lipid choice for infants who needed longer courses of PN or had developed cholestasis. Despite longer PN duration, and higher baseline CB, overall rates of IFALD decreased with composite ILE. Regardless of parenteral lipid used, there were no differences in growth.