Abstract
Total parenteral nutrition (TPN) is a life-saving intervention for infants that are unable to feed by mouth. Infants that remain on TPN for extended periods of time are at risk for the development of liver injury in the form of parenteral nutrition associated cholestasis (PNAC). Current research suggests the lipid component of TPN is a factor in the development of PNAC. Most notably, the fatty acid composition, vitamin E concentration, and presence of phytosterols are believed key mediators of lipid emulsion driven PNAC development. New emulsions comprised of fish oil and medium chain triglycerides show promise for reducing the incidence of PNAC in infants. In this review we will cover the current clinical studies on the benefit of fish oil and medium chain triglyceride containing lipid emulsions on the development of PNAC, the current constituents of lipid emulsions that may modulate the prevalence of PNAC, and potential new supplements to TPN to further reduce the incidence of PNAC.
Highlights
Total parenteral nutrition (TPN) was first established as a life-saving approach for nutritional support in infants in 1968 [1,2]
While the provision of TPN containing lipid emulsions has successfully reduced the overall mortality of premature infants and infants that are intractable to enteral feeding, there have been a number of diseases that have arisen from its use
This review reports on the current knowledge of lipid emulsions and how they impact the development of cholestatic liver disease in infants
Summary
Total parenteral nutrition (TPN) was first established as a life-saving approach for nutritional support in infants in 1968 [1,2]. Initial studies into TPN related liver disease in infancy noticed that cholestasis was a common underlying factor, which was observed even prior to the initiation of lipid emulsion supplementation. The term intestinal failure associated liver disease (IFALD) is more readily used in the literature when the liver disease occurs in infants with intestinal resection. Many early studies examining the development of PNAC related to lipid emulsions have not differentiated between the causes of TPN treatment. For this reason, we will use the more general term, PNAC, in this review. Lipid emulsion composition is a modifiable factor related to PNAC that can reduce the likelihood of disease onset and perhaps disease resolution. The potential mechanisms that drive cholestatic liver disease are discussed, as well as, potential ingredients that may be added to lipid emulsions to reduce the development of cholestatic liver disease
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