Division of Pediatric Surgery, University of Texas Southwestern/Children's Health, Dallas, TX, USA.
Division of Gastroenterology, University of Texas Southwestern/Children's Health, Dallas, TX, USA.
J Pediatr Surg. 2020 Jan;55(1):153-157. doi: 10.1016/j.jpedsurg.2019.09.073. Epub 2019 Oct 25.
Cholestasis is problematic for infants with intestinal failure (IF). The soy-based lipid Intralipid® (IL) has been implicated. An alternative, Smoflipid® (SMOF), is increasingly used. However, its role in cholestasis prevention is unclear. This study compares the incidence and degree of cholestasis between infants with IF receiving SMOF or IL.
Infants with IF receiving SMOF or IL during the first 8 weeks of parenteral nutrition (PN) support between 2014 and 2017 were reviewed. Clinical characteristics, cholestasis incidence (conjugated bilirubin (Cbili) >2 mg/dL for >2 weeks), and nutritional parameters were compared using Welch's t-test.
91% (21/23) of IL and 76% (16/21) of SMOF babies became cholestatic (p = 0.18). There was no significant difference in median peak Cbili, but SMOF babies normalized more quickly (p = 0.04). Median z-scores for weight were similar throughout the study. SMOF patients getting full PN had a lower incidence of cholestasis compared to IL patients (78% vs. 92%, p = 0.057), but those with cholestasis had similar peak Cbili, time to resolution, and growth.
Early use of Smoflipid® did not reduce the incidence of cholestasis compared to Intralipid® in infants with IF, but hyperbilirubinemia did resolve more quickly. SMOF may be most beneficial for infants tolerating no enteral nutrition.
Level III Retrospective Comparative Treatment Study.
Retrospective Review.
胆汁淤积症是肠衰竭（IF）婴儿的一个问题。大豆基脂质 Intralipid®（IL）与此有关。另一种替代品 Smoflipid®（SMOF）越来越多地被使用。然而，其在预防胆汁淤积症方面的作用尚不清楚。本研究比较了接受 SMOF 或 IL 治疗的 IF 婴儿的胆汁淤积症发生率和严重程度。
回顾了 2014 年至 2017 年期间接受静脉营养（PN）支持的 IF 婴儿在最初 8 周内接受 SMOF 或 IL 的情况。使用 Welch's t 检验比较了临床特征、胆汁淤积症发生率（结合胆红素（Cbili）>2mg/dL 持续>2 周）和营养参数。
IL 组的胆汁淤积发生率为 91%（21/23），SMOF 组为 76%（16/21）（p=0.18）。中位峰值 Cbili 无显著差异，但 SMOF 婴儿恢复更快（p=0.04）。整个研究过程中，体重的 z 评分中位数相似。接受全 PN 的 SMOF 患者的胆汁淤积发生率低于 IL 患者（78% vs. 92%，p=0.057），但有胆汁淤积的患者的峰值 Cbili、恢复时间和生长情况相似。
与 IF 婴儿中使用 Intralipid®相比，早期使用 Smoflipid®并未降低胆汁淤积症的发生率，但高胆红素血症确实恢复得更快。SMOF 可能对不能耐受任何肠内营养的婴儿最有益。
III 级回顾性比较治疗研究。
回顾性综述。
