Abstract:

Background: Composite lipid emulsion (CLE) composed of soybean oil, medium-chain triglycerides, olive oil and fish oil is approved in the US for parenterally fed adults. For stable children discharged on home parenteral nutrition (HPN) without cholestasis (direct bilirubin > 2.0 mg/dL), CLE has theoretical benefits over soybean-based intravenous lipid emulsion due to reduced phytosterol exposure with higher calorie support to permit reduced glucose infusion rates, omega-3 supplementation, as well as supplemental α-tocopherol.

Methods: In this prospective, single-center open-label research study, safety and efficacy outcomes were evaluated in patients on HPN ages <18y treated with CLE at 1-3 g/kg/d over 12-months. The primary outcome was change in anthropometrics and glucose infusion rates compared with baseline. Secondary outcomes were changes in fatty acid profiles and liver function and enzyme tests compared with baseline.

Results: Fifty-seven subjects were treated with a median age of 7 years. The diagnosis was short bowel syndrome in 72%. Change in practice was associated with a decrease in mean glucose infusion rates from 17 to 14 mg/kg/hr at 4-6 months post-baseline and beyond with a coincidental decline in mean arachidonic acid and stable growth parameters. No significant adverse events were noted.

Conclusions: CLE was safe and well-tolerated in stable children on HPN at one year, but further studies are needed in this population to appreciate long-term outcomes.

Reference:

Raphael BP, Mitchell PD, Carey A, Gura KM, Puder M. One-Year Experience with Composite Intravenous Lipid Emulsion in Children on Home Parenteral Nutrition. J Pediatr Gastroenterol Nutr. 2020 Nov 30. doi: 10.1097/MPG.0000000000003011. Epub ahead of print. PMID: 33264184.