SO,MCT,OO,FO-ILE Is Associated With Better Side Effect Profile Than SO-ILE in Critically Ill Children Receiving Parenteral Nutrition

Abstract

OBJECTIVES This study aimed to evaluate the side effect profile of soybean oil lipid injectable emulsion (SO-ILE) and soybean oil, medium-chain triglyceride, olive oil, fish oil lipid injectable emulsion (SO,MCT,OO,FO-ILE) in critically ill children requiring parenteral nutrition (PN). METHODS This is an observational study of children admitted to our pediatric intensive care unit requiring PN for ≥7 days. Patients were divided into 2 cohorts: SO,MCT,OO,FO-ILE (n = 34) and SO-ILE (n = 111). Outcomes included development of hypertriglyceridemia (HTG), intestinal failure–associated liver disease (IFALD), length of stay, and mortality. Logistic regression was performed after controlling for duration and maximum dose of lipids. RESULTS The median maximum lipid dose was significantly higher in the SO,MCT,OO,FO-ILE cohort (2.7 vs 3 g/kg; p = 0.01). Prevalence of baseline HTG was similar in both cohorts. After excluding patients with baseline HTG, incidence of HTG upon PN introduction was higher in the SO-ILE cohort (51.2% vs 26.7%; p = 0.02). The SO-ILE cohort also had significantly higher triglyceride concentrations at peak and upon discontinuation of PN (p < 0.05). Direct bilirubin and C-reactive protein were significantly higher in the SO-ILE cohort after stopping PN. Five patients (3.4%) developed IFALD, 4 of whom were in the SO-ILE cohort (p = 0.85). Upon logistic regression, mortality rate and incidence of HTG remained significantly higher in the SO-ILE cohort (adjusted odds ratio, 2.3 [95% CI, 1.1–5.3]; p = 0.04; and adjusted odds ratio, 2.0 [95% CI, 1.3–5.1]; p = 0.03, respectively). CONCLUSIONS In critically ill children requiring PN, SO-ILE was associated with a higher risk of HTG, elevated direct bilirubin, inflammatory markers and mortality compared with SO,MCT,OO,FO-ILE. ABBREVIATIONS CRP, C-reactive protein; FA, fatty acid; HTG, hypertriglyceridemia; IFALD, intestinal failure– associated liver disease; ILE, lipid injectable emulsion; IQR, interquartile range; LOS, length of stay; MO-ILE, multicomponent oil lipid injectable emulsion; PICU, pediatric intensive care unit; PN, parenteral nutrition; SO-ILE, soybean oil lipid injectable emulsion; SO,MCT,OO,FO-ILE, soybean oil, medium chain triglyceride, olive oil, fish oil lipid injectable emulsion; TG, triglyceride.