Parenteral Nutrition-Associated Cholestasis; A Comparison Between Soy-Based Lipids and Mix-Based Lipids in the High-Risk Surgical Neonates

Abstract

Background: Parenteral nutrition-associated cholestasis (PNAC) is a significant concern in high-risk surgical neonates, contributing to morbidity and prolonged hospitalization. This retrospective observational study aimed to investigate the impact of different lipid emulsions on the incidence and severity of PNAC in this vulnerable population while controlling for concomitant factors. Material and methods: A cohort of 67 surgical neonates was included, with 35 receiving IntralipidⓇ (IL) and 32 receiving SMOFlipidⓇ (SL). Rigorous inclusion criteria were applied to ensure comparability between the groups, focusing on the type of lipid emulsion as the main difference and selecting patients with prolonged fasting, limited oral intake, and significant PN reliance. The cumulative incidence of PNAC, absolute risk reduction (ARR), odds ratio (OR), and the effect on specific liver function tests, such as conjugated bilirubin (CB) and gamma-glutamyl transferase (GGT), were evaluated. Results: The SL group exhibited a significantly lower incidence of PNAC compared to the IL group (22% vs. 57%, p=0.0057), highlighting the potential protective effect of SL against PNAC development in surgical neonates. Subgroup analysis revealed a lower incidence of PNAC in full-term neonates receiving SL compared to IL (16% vs. 52%, p=0.0219), while the difference did not reach statistical significance in premature neonates. Furthermore, SL was associated with a marked reduction in the rise of CB levels compared to IL (34 vs. 66 umol/l, p=0.0093), indicating a potential hepatoprotective effect. Conclusions: This study emphasizes high-risk surgical neonates' susceptibility to PNAC. The incidence of PNAC exceeded reported rates in lower-risk neonates, highlighting their unique challenges. Although SL reduced PNAC risk compared to IL, the absolute rate remained high and of questionable benefit in surgical premature neonates. These findings prompt further investigation into the optimal lipid emulsion for this vulnerable population, weighing the benefits of SL against potential drawbacks.