Background Parenteral nutrition associated liver disease (PNALD) accounts for substantial morbidity and mortality in infants with intestinal failure. Lipid formulations and sepsis may be important determinants. Newer lipid preparations for example, SMOFlipid (SMOF) containing ω-3 and medium chain triglycerides have theoretical benefits over standard soya-based lipid for example, Intralipid (IL) and may minimise PNALD.
Aim To investigate the effects of lipid formulation and sepsis on liver function in neonates with PNALD.
Methods A retrospective review of infants with PNALD, (conjugated bilirubin (CB) of over 50 μmol/l), commenced initially on IL and changed to SMOF, as per unit policy. CB was compared before and after change in lipid formulation. Additionally, effects of sepsis episodes (CRP rise >30 mg/l) on liver function were investigated. Concomitantly, enteral feeding was recorded.
Results Pilot data on the first 5 infants shows a reduction in CB level after changing from IL to SMOF (91±36 vs 62±11 μmol/l, p=0.0007). Sepsis was associated with an increase in CB (66±14 vs 77±20 μmol/l, p=0.009) and ALT (85±46 vs 114±77 μmol/l, p=0.05). Graphical analysis additionally suggests a trend for improved liver function with increased proportion of feed volumes.
Conclusions Change from IL to SMOF is associated with improved liver function in PNALD. Sepsis episodes contribute to worsening PNALD. Analysis of an extended cohort (in progress) may further delineate the relative contributions of lipid formulation, sepsis and enteral feeding in PNALD.
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