Intermountain Healthcare, Utah Valley Hospital, Provo, Utah, USA.
Intermountain Healthcare, Primary Children's Hospital, Salt Lake City, Utah, USA.
JPEN J Parenter Enteral Nutr. 2021 Feb;45(2):339-346. doi: 10.1002/jpen.1843. Epub 2020 May 11.
Parenteral nutrition (PN) is critical for the growth and development of premature neonates who are unable to reach nutrition goals enterally. Using soybean-oil emulsions in PN is a risk factor for cholestasis, leading to alternative dosing strategies including a reduction in total lipid prescribed. Recently, SMOFlipid has been utilized with the goal of avoiding cholestasis while maintaining energy intake. The aim of our study was to compare the incidence of PN-associated cholestasis (PNAC) in patients admitted to the neonatal intensive care unit (NICU) who received either Intralipid 20% or SMOFlipid.
This single-center, retrospective study evaluated all NICU patients who received PN for ≥14 days. Patients who received SMOFlipid were compared with those who received Intralipid. The primary end point was incidence of PNAC. Secondary end points included (1) prevalence of elevated liver function tests; (2) effect on select laboratory parameters; (3) development of PNAC by age; and (4) incidence of retinopathy of prematurity.
A total of 136 neonates were included. Nine of 55 patients (16.4%) in the Intralipid group and 2 of 81 patients (2.5%) in the SMOFlipid group developed cholestasis, defined as direct bilirubin > 2 mg/dL or direct bilirubin > 20% of total bilirubin, when total bilirubin is >5 mg/dL, on or before 30 days post initiation of PN (P = .007).
Use of SMOFlipid as the lipid emulsion component of PN may be beneficial in prevention of PNAC in NICU patients that are receiving PN for ≥2 weeks.
肠外营养（PN）对于无法通过肠道达到营养目标的早产儿的生长发育至关重要。在 PN 中使用大豆油乳剂是胆汁淤积的一个风险因素，导致替代剂量策略，包括减少规定的总脂质。最近，SMOFlipid 已被用于避免胆汁淤积，同时保持能量摄入。我们的研究目的是比较接受肠外营养的新生儿重症监护病房（NICU）患者中使用 Intralipid 20%或 SMOFlipid 时，与肠外营养相关的胆汁淤积（PNAC）的发生率。
这项单中心、回顾性研究评估了所有接受 PN 治疗≥14 天的 NICU 患者。将接受 SMOFlipid 的患者与接受 Intralipid 的患者进行比较。主要终点是 PNAC 的发生率。次要终点包括（1）肝酶升高的发生率；（2）对特定实验室参数的影响；（3）按年龄发展的 PNAC；和（4）早产儿视网膜病变的发生率。
共纳入 136 名新生儿。Intralipid 组 55 名患者中有 9 名（16.4%）和 SMOFlipid 组 81 名患者中有 2 名（2.5%）发生了胆汁淤积，定义为直接胆红素>2mg/dL 或直接胆红素>总胆红素的 20%，当总胆红素>5mg/dL 时，在开始 PN 后 30 天内出现（P=0.007）。
在接受 PN 治疗≥2 周的 NICU 患者中，使用 SMOFlipid 作为 PN 的脂质乳剂成分可能有助于预防 PNAC。
