title: Impact of parenteral fat composition on cholestasis in preterm infants.
abstract: OBJECTIVE
  Parenteral nutrition-associated liver disease (PNALD) is frequently detected in neonatal intensive care units. Parenteral lipid emulsion (PLE) content has been implicated in its pathogenesis. We aimed to study the effect on incidence and outcome of PNALD by replacing soy-based PLE with olive oil-based PLE in a population-based group of preterm infants.
  
  
  METHODS
  All infants in Stockholm County with gestational age (GA) <30 weeks were included (n = 615). Infants who died before 28 days of age or were referred to or from other regions were excluded (n = 97). PNALD was defined as conjugated serum bilirubin ≥ 30 μmol/L and exceeding 20% of the total fraction on at least 2 occasions. Two different 2-year time periods were compared: before (SOY period) and after (OLIVE period) switching PLE. For each PNALD case, 2 GA-matched controls were randomly identified.
  
  
  RESULTS
  PNALD incidence was 14.8% (37/250) in the SOY period and 12.7% (34/268) in the OLIVE period (P = 0.52). The OLIVE infants with PNALD had more risk factors, such as lower GA and longer periods of parenteral nutrition, for developing PNALD than the SOY infants. Nevertheless, treatment during the SOY period was an independent risk factor for PNALD in logistic regression analysis.
  
  
  CONCLUSIONS
  Population-based incidence of PNALD is 1 of 7 in preterm infants with GA < 30 weeks. Changing from soy oil to olive oil-based PLE did not decrease the incidence of PNALD significantly. Olive oil-based PLE carries an equal or slightly decreased risk to develop PNALD compared with soy oil-based PLE.
authors: Pediatric Unit, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
authors: Jonas
authors: J
authors: Teng
authors: Henrik
authors: H
authors: Arnell
authors: Kajsa
authors: K
authors: Bohlin
authors: Antal
authors: A
authors: Nemeth
authors: Björn
authors: B
authors: Fischler
mesh_terms: D016022:Case-Control Studies; D002779:Cholestasis / Q000178:diet therapy / Q000517:prevention & control*; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D007363:Intensive Care Units, Neonatal; D008297:Male; D000069463:Olive Oil / Q000008:administration & dosage*; D010288:Parenteral Nutrition / Q000009:adverse effects*; D011247:Pregnancy; D013024:Soybean Oil / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D005217:Fat Emulsions, Intravenous; D000069463:Olive Oil; D013024:Soybean Oil