title: The effect of lipid restriction on the prevention of parenteral nutrition-associated cholestasis in surgical infants.
abstract: OBJECTIVE
  Surgical infants requiring long-term parenteral nutrition (PN) are at risk for parenteral nutrition-associated liver disease (PNALD). The purpose of this study was to determine the effect of a lipid restricted PN regimen in preventing the development of PNALD in surgical infants.
  
  
  METHODS
  In 2009, we implemented a lipid restricted strategy in surgical infants expected to be on long-term PN using a soy-based lipid emulsion at a goal provision of 1g/kg/day throughout a patient's entire PN course. An experimental cohort of surgical infants treated with lipid restriction from 2009 to 2011 (n=82) was retrospectively compared to a control cohort of infants from 2005 to 2008 receiving standard intravenous lipid dosing (n=132). A multivariable relative risk regression model was constructed analyzing the association between lipid restriction and PNALD.
  
  
  RESULTS
  Patients admitted during the lipid restriction era had reduced daily lipid provisions compared to the control group (p<0.001). There were no significant differences in demographic or measured clinical characteristics between the two groups. A significant reduction in the incidence of PNALD was demonstrated in the lipid restricted group compared to the control group (22% vs. 43%, p=0.002). On multivariable relative risk regression, patients treated with standard lipid provisions were 1.77 times more likely to develop PNALD than patients who were lipid restricted (95% CI: 1.2-2.7; p=0.007).
  
  
  CONCLUSIONS
  Restriction of intravenous soy-based lipid in PN-fed surgical infants is associated with a reduction in the incidence of liver disease. Early lipid restriction should be considered in all surgical infants who require PN as a preventative measure against PNALD.
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA 98105, USA.
authors.forename: Sabrina E
authors.initials: SE
authors.lastname: Sanchez
authors.forename: Lindsay P
authors.initials: LP
authors.lastname: Braun
authors.forename: Laina D
authors.initials: LD
authors.lastname: Mercer
authors.forename: Meredith
authors.initials: M
authors.lastname: Sherrill
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stevens
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Javid
mesh_terms: D002779:Cholestasis / Q000209:etiology* / Q000517:prevention & control*; D018752:Diet, Fat-Restricted; D005217:Fat Emulsions, Intravenous / Q000494:pharmacology*; D006801:Humans; D007223:Infant; D010288:Parenteral Nutrition / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control*; D012189:Retrospective Studies
chemical_list: D005217:Fat Emulsions, Intravenous