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Soybean‐Oil Lipid Minimization for Prevention of Intestinal Failure–Associated Liver Disease in Late‐Preterm and Term Infants With Gastrointestinal Surgical Disorders
Author(s) -
Gupta Kunal,
Wang Hongyue,
Amin Sanjiv B.
Publication year - 2021
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.2004
Subject(s) - medicine , liver disease , gastroenterology , gestational age , randomized controlled trial , parenteral nutrition , bilirubin , surgery , pediatrics , pregnancy , biology , genetics
Background Intestinal failure‐associated liver disease (IFALD), a multifactorial disease, is common among infants with gastrointestinal surgical disorders (GISDs). Prolonged soy‐based intravenous lipid emulsion (S‐ILE) intake is associated with IFALD, but preventive studies of limiting S‐ILE have been inconclusive. Furthermore, a double–blind, randomized preventive trial (DBRPT) of S‐ILE intake has not been performed in infants with GISDs. Our objective was to compare the effect of 1 g/kg/d vs 2 g/kg/d S‐ILE intake for 6 weeks on the incidence of IFALD and the rate of rise of direct bilirubin (DB) in infants with GISDs. Methods A DBRPT was conducted in infants with GISDs at ≥34 weeks’ gestational age (GA) admitted to the NICU within 72 hours after birth. Infants were randomized in a 1:1 ratio to receive either 1 or 2 g/kg/d S‐ILE for 6 weeks. IFALD was defined as DB ≥2 mg/dL. Results Forty infants were studied. The 2 groups had similar clinical characteristics except for GA and blood group incompatibility. Thirty percent of infants in each group developed IFALD ( P = .94). However, infants in the group receiving 1 g/kg/d S‐ILE (n = 20) had a lower rate of rise of DB compared with infants in the group receiving 2 g/kg/d S‐ILE (n = 20). Conclusions Reducing S‐ILE intake for 6 weeks in infants with GISD at ≥34 weeks’ GA may not prevent IFALD. The extrapolated data on the rate of rise of DB suggest a possible risk of earlier development of IFALD with S‐ILE intake of 2 g/kg/d, as compared with 1 g/kg/d, beyond the 6‐week study period.