J Clin Nutr.  2017 Jun;9(1):21-29. 10.15747/jcn.2017.9.1.21.

Influence of Fish Oil-Containing Lipid Emulsions on Parenteral Nutrition-Associated Liver Disease in Neonates

• Park JA
• Park JE
• Jeong MJ
• Kim JS
• Son ES
• Eun HS

• KMID: 2385923
• DOI: http://doi.org/10.15747/jcn.2017.9.1.21

Abstract

PURPOSE
This study is a comparative evaluation of the incidence of parenteral nutrition-associated liver disease (PNALD) when administering intravenous fat emulsions containing fish oil.
METHODS
The medical records of patients who were in the neonatal intensive care unit at Severance Hospital from January, 2012 to December 2015, were reviewed retrospectively. Patients who were administered either soybean oil (SO) or SMOF (containing soybean oil, medium chain triglycerides, olive oil, and fish oil) more than 14 days were included. The patients were excluded if they were administered both agents or had underlying hepatic disease. An increase in bilirubin to 2 mg/dL was defined as PNALD.
RESULTS
PNALD occurred in only 8 out of a total of 77 patients: 6 out of 31 (19.4%) in the SO group and 2 out of 46 (4.3%) in the SMOF group (P=0.055). The number of patients, whose lab values, such as direct bilirubin, total bilirubin, asparate aminotransferase (AST), alanine amino-transferase, gamma-glutamyl transpeptidase, C-reactive protein, serum triglyceride, and alkaline phosphate, exceeded the normal range, were similar in both groups. The gestational age, birth body weight, and APGAR score at 1 min and 5 min were significantly higher in the SO group and the PN duration was significantly long in the SMOF group. Considering only term infants, there were no significant differences in baseline characteristics and incidence of PNALD. The number of patients whose AST exceeded the normal range was significantly higher in the SO group (P=0.034).
CONCLUSION
The incidence of PNALD was similar in both groups. On the other hand, considering the tendency, there was a high correlation between the type of lipid emulsion and an increased direct bilirubin level in the SO group.

Keyword

Parenteral nutrition; Intravenous fat emulsions; Soybean oil; Fish oils

MeSH Terms

Alanine
Apgar Score
Bilirubin
Body Weight
C-Reactive Protein
Emulsions*
Fat Emulsions, Intravenous
Fish Oils
gamma-Glutamyltransferase
Gestational Age
Hand
Humans
Incidence
Infant
Infant, Newborn*
Intensive Care, Neonatal
Liver Diseases*
Liver*
Medical Records
Olive Oil
Parenteral Nutrition
Parturition
Reference Values
Retrospective Studies
Soybean Oil
Triglycerides
Alanine
Bilirubin
C-Reactive Protein
Emulsions
Fat Emulsions, Intravenous
Fish Oils
Olive Oil
Soybean Oil
Triglycerides
gamma-Glutamyltransferase