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Lipid Emulsion Use in Pediatric Patients Requiring Long‐Term Parenteral Nutrition
Author(s) -
Goulet Olivier J.,
Cai Wei,
Seo JeongMeen
Publication year - 2020
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1762
Subject(s) - parenteral nutrition , fish oil , soybean oil , cholestasis , phytosterol , medicine , polyunsaturated fatty acid , eicosapentaenoic acid , liver disease , docosahexaenoic acid , intestinal failure , gastroenterology , short bowel syndrome , physiology , food science , fatty acid , biochemistry , biology , fish <actinopterygii> , pathology , fishery
The ability to deliver nutrients via parenteral nutrition (PN) has markedly improved the prognosis of infants and children with intestinal failure. Technical refinements and advances in knowledge have led to the development of highly sophisticated PN solutions that are tailored to meet the needs of pediatric patients. However, children who require long‐term PN have an increased risk of complications such as catheter‐related sepsis, liver disease, and bone disease. Although the pathogenesis of intestinal failure associated liver disease (IFALD) is multifactorial, studies have identified a possible link between the dose of lipid emulsions based on soybean oil and cholestasis, shown to occur with a significantly higher frequency in patients receiving >1 g lipids/kg/d. Potential contributing factors include oxidative stress, high ω‐6 polyunsaturated fatty acid (PUFA) and phytosterol content, and relatively low α‐tocopherol levels. Lipid emulsions containing fish oil offer potential advantages compared with traditional emulsions with a high soybean oil content, such as decreased ω‐6 and increased ω‐3 PUFA concentrations, high concentrations of α‐tocopherol, and reduced phytosterol content. Studies in PN‐dependent children at risk for IFALD have shown that lipid emulsions containing fish oil reduce the risk of cholestasis and improve biochemical measures of hepatobiliary function compared with pure soybean oil emulsions. This review summarizes evidence regarding the role of lipid emulsions in the management of pediatric patients with intestinal failure requiring long‐term PN, with a particular focus on the prevention and treatment of IFALD.