title: Resolution of parenteral nutrition-associated jaundice on changing from a soybean oil emulsion to a complex mixed-lipid emulsion.
abstract: OBJECTIVE
  Resolution of parenteral nutrition (PN)-associated jaundice has been reported in children given a reduced dose of intravenous fat using a fish oil-derived lipid emulsion. The aim of the present study was to examine the effect on PN-associated jaundice of changing from a soybean oil-derived lipid to a mixed lipid emulsion derived from soybean, coconut, olive, and fish oils without reducing the total amount of lipid given.
  
  
  METHODS
  Retrospective cohort comparison examining serum bilirubin during 6 months in children with PN-associated jaundice who changed to SMOFlipid (n=8) or remained on Intralipid (n=9).
  
  
  RESULTS
  At entry, both groups received most of their energy as PN (SMOFlipid 81.5%, range 65.5-100 vs Intralipid 92.2%, range 60.3-100; P=0.37). After 6 months, both tolerated increased enteral feeding but still received large proportions of their energy as PN (SMOFlipid 68.4%, range 36.6-100 vs Intralipid 50%, range 37.6-76; P=0.15). The median bilirubin at the outset was 143 μmol/L (range 71-275) in the SMOFlipid group and 91 μmol/L (range 78-176) in the Intralipid group. After 6 months, 5 of 8 children in the SMOFlipid and 2 of 9 children in the Intralipid group had total resolution of jaundice. The median bilirubin fell by 99 μmol/L in the SMOFlipid group but increased by 79 μmol/L in the Intralipid group (P=0.02).
  
  
  CONCLUSIONS
  SMOFlipid may have important protective properties for the liver and may constitute a significant advance in PN formulation. Randomised trials are needed to study the efficacy of SMOFlipid in preventing PN liver disease.
authors.affiliation: Department of Paediatric Gastroenterology, University of Birmingham, Birmingham, UK.
authors.forename: Rafeeq
authors.initials: R
authors.lastname: Muhammed
authors.forename: Ronald
authors.initials: R
authors.lastname: Bremner
authors.forename: Sue
authors.initials: S
authors.lastname: Protheroe
authors.forename: Tracey
authors.initials: T
authors.lastname: Johnson
authors.forename: Chris
authors.initials: C
authors.lastname: Holden
authors.forename: M Stephen
authors.initials: MS
authors.lastname: Murphy
mesh_terms: D001663:Bilirubin / Q000097:blood; D002675:Child, Preschool; D000074263:Coconut Oil; D004041:Dietary Fats / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D005217:Fat Emulsions, Intravenous / Q000737:chemistry; D005395:Fish Oils / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007565:Jaundice / Q000188:drug therapy* / Q000209:etiology; D008099:Liver / Q000187:drug effects*; D000069463:Olive Oil; D010288:Parenteral Nutrition / Q000009:adverse effects* / Q000379:methods; D010289:Parenteral Nutrition, Total; D010938:Plant Oils / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D012189:Retrospective Studies; D013024:Soybean Oil / Q000009:adverse effects*
chemical_list: D004041:Dietary Fats; D005217:Fat Emulsions, Intravenous; D005395:Fish Oils; D000069463:Olive Oil; D010938:Plant Oils; D013024:Soybean Oil; D000074263:Coconut Oil; D001663:Bilirubin