Background and aims Parenteral nutrition associated liver disease (PNALD) accounts for substantial morbidity and mortality in infants with intestinal failure. Lipid formulations may be important determinants of PNALD development. Newer lipid preparations e.g. SMOF lipid (SMOF) containing omega-3 and medium chain triglycerides have theoretical benefits over standard soya-based lipid (eg: intralipid (IL) and may minimise PNALD. This study aimed to investigate the effects of a change in lipid formulation, from IL to SMOF, on liver function in infants with PNALD.
Method This retrospective review was performed following an initial pilot study. Data were obtained by case-note review of infants with PNALD (conjugated bilirubin (CB) >50 µmol/L) commenced initially on IL and subsequently changed to SMOF, as per Unit protocol. Liver function (CB, AST, ALT levels, and the change in each of these per week: ΔCB, ΔAST, ΔALT) was compared before and after change in lipid (figure 1).
Results Data were obtained for 14 infants of median (range) gestation 29 (24-40) weeks, birth weight 1.23 (0.53-3.66) kg. Median duration of parenteral nutrition was 89 (19-212) days. Median age at change from IL to SMOF was 50 (22-142) days.
Change from IL to SMOF was associated with a significant reduction in ΔCB after 2 weeks and 4 weeks of SMOF therapy (table 1 and figure 1) i.e. the weekly rate of increase in CB levels was reduced (and later reversed) after change to SMOF. Accordingly, absolute CB levels stabilised after change from IL to SMOF. ΔAST and ΔALT, and absolute levels of AST and ALT, also trended lower after 4 weeks of SMOF therapy.
Conclusions Change from IL to SMOF was associated with improved liver function in infants with PNALD. This data supports the use of SMOF in infants requiring long-term PN therapy to minimise PNALD. Further study is required to determine the optimum timing for commencement of SMOF use.