Low-dose parenteral soybean oil for the prevention of parenteral nutrition-associated liver disease in neonates with gastrointestinal disorders

Kara L. Calkins, Thomas G. Havranek, Lorraine I. Kelley-Quon, Laura Cerny, Martiniano Flores, Tristan Grogan, Stephen B. Shew

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Background: Neonates with gastrointestinal disorders (GDs) are at high risk for parenteral nutrition-associated liver disease (PNALD). Soybean-based intravenous lipid emulsions (S-ILE) have been associated with PNALD. This study's objective was to determine if a lower dose compared with a higher dose of S-ILE prevents cholestasis without compromising growth. Materials and Methods: This multicenter randomized controlled pilot study enrolled patients with GDs who were ≤5 days of age to a low dose (∼1 g/kg/d) (LOW) or control dose of S-ILE (∼3 g/kg/d) (CON). The primary outcome was cholestasis (direct bilirubin [DB] >2 mg/dL) after the first 7 days of age. Secondary outcomes included growth, PN duration, and late-onset sepsis. Results: Baseline characteristics were similar between the LOW (n = 20) and CON groups (n = 16). When the LOW group was compared with the CON group, there was no difference in cholestasis (30% vs 38%, P =.7) or secondary outcomes. However, mean ± SE DB rate of change over the first 8 weeks (0.07 ± 0.04 vs 0.3 ± 0.09 mg/dL/wk, P =.01) and entire study (0.008 ± 0.03 vs 0.2 ± 0.07 mg/dL/wk, P =.02) was lower in the LOW group compared with the CON group. Conclusion: In neonates with GDs who received a lower dose of S-ILE, DB increased at a slower rate in comparison to neonates who received a higher dose of S-ILE. Growth was comparable between the groups. This study demonstrates a need for a larger, randomized controlled trial comparing 2 different S-ILE doses for cholestasis prevention in neonates at risk for PNALD.

Original languageEnglish (US)
Pages (from-to)404-411
Number of pages8
JournalJournal of Parenteral and Enteral Nutrition
Volume41
Issue number3
DOIs
Publication statusPublished - Mar 1 2017

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Keywords

  • cholestasis
  • gastrointestinal disorders
  • neonates
  • parenteral nutrition
  • soybean oil

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

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