Use of Intravenous Soybean and Fish Oil Emulsions in Pediatric Intestinal Failure-Associated Liver Disease: A Multicenter Integrated Analysis Report on Extrahepatic Adverse Events

Abstract

To compare extrahepatic adverse events during fish oil lipid emulsion (FOLE) or soybean oil lipid emulsion (SOLE) treatment in children with intestinal failure-associated liver disease (IFALD). In this multicenter integrated analysis, bleeding, bronchopulmonary dysplasia (BPD), retinopathy ofprematurity (ROP), infections, and signs of lipid emulsion intolerance were compared between FOLE recipients (1g/kg/d) (n=189) and historical controls who received SOLE (≤3g/kg/d) (n=73). When compared with SOLE recipients, FOLE recipients had a lower gestational age (30.5 vs 33.0weeks; P=.0350) and higher baseline direct bilirubin (DB) (5.8 vs 3.0mg/dL; P<.0001). FOLE recipients had a decreased incidence of bleeding (P<.0001), BPD (P<.001), ROP (P<.0156), bacterial and fungal infections (P<.0001), and lipid intolerance signs (P<.02 for all). Patients with bleeding vs patients without bleeding had higher baseline DB; the ORs for baseline DB (by mg/dL) and treatment (FOLE vs SOLE) were 1.20 (95% CI: 1.10, 1.31; P≤.0001) and 0.22 (95% CI: 0.11, 0.46; P≤.0001), respectively. In preterm infants, a higher BPD (P<.0001) and ROP incidence (P=.0071) was observed in SOLE recipients vs FOLE recipients. Children with IFALD who received FOLE had fewer extrahepatic adverse events, including a decreased incidence of bleeding, preterm comorbidities, and lipid intolerance signs compared with children with IFALD who received SOLE. TRIAL REGISTRATION CLINICALTRIALS.GOV: NCT00910104 and NCT00738101.