Wesley Children's Hospital, Wichita, Kansas, USA.
Wichita Medical Research and Education Foundation, Wichita, Kansas, USA.
JPEN J Parenter Enteral Nutr. 2020 Nov;44(8):1530-1534. doi: 10.1002/jpen.1774. Epub 2020 Feb 6.
Intravenous lipid emulsions (ILEs) are a risk factor for parenteral nutrition-associated liver disease (PNALD) in the neonatal population. Current literature supports the use of SMOFlipid (4-oil ILE), a fish oil-containing lipid emulsion, for the reversal of PNALD. However, there is little information about the use of 4-oil ILEs for preventing PNALD. The purpose of this study is to examine the safety of a 4-oil ILE in neonates and its effectiveness in preventing PNALD among neonates compared with Intralipid (a soybean-oil, SO-ILE).
This is an observational, cohort, comparative safety study, conducted in a level III neonatal intensive care unit. Participants include neonates who received a 4-oil ILE in their parenteral nutrition (PN) formula, who were matched with historical data of patients who received an SO-ILE, in a 1:3 fashion (4-oil ILE:SO-ILE). The primary outcome of this study is the presence of PNALD (defined as direct bilirubin > 2 mg/dL) after initiation of PN.
A total of 1332 participants (333 4-oil ILE vs 999 SO-ILE) were included in the data analysis, and PNALD was found to occur in 1.8% of patients in the 4-oil ILE group and 3.6% of patients in the SO-ILE group (Relative risk (RR) 0.5; 95% CI, 0.21-1.18).
The decrease in the incidence of PNALD among the 4-oil ILE group compared with the SO-ILE group indicates a 4-oil ILE may have a hepatoprotective effect.
静脉内脂肪乳剂（ILE）是新生儿人群中肠外营养相关肝病（PNALD）的一个危险因素。目前的文献支持使用含有鱼油的脂肪乳剂 SMOFlipid（4 油 ILE）来逆转 PNALD。然而，关于使用 4 油 ILE 预防 PNALD 的信息很少。本研究的目的是研究 4 油 ILE 在新生儿中的安全性及其与 Intralipid（大豆油，SO-ILE）相比预防 PNALD 的效果。
这是一项在三级新生儿重症监护病房进行的观察性、队列、比较安全性研究。参与者包括接受肠外营养（PN）配方中 4 油 ILE 的新生儿，这些新生儿与接受 SO-ILE 的患者的历史数据以 1:3 的比例匹配（4 油 ILE：SO-ILE）。本研究的主要结局是在开始 PN 后是否存在 PNALD（定义为直接胆红素>2mg/dL）。
共有 1332 名参与者（333 名 4 油 ILE 与 999 名 SO-ILE）纳入数据分析，4 油 ILE 组中 PNALD 的发生率为 1.8%，SO-ILE 组中为 3.6%（相对风险（RR）0.5；95%CI，0.21-1.18）。
与 SO-ILE 组相比，4 油 ILE 组 PNALD 的发生率下降表明 4 油 ILE 可能具有肝保护作用。
