title: Reduced risk of pulmonary emboli in children treated with long-term parenteral nutrition.
abstract: Pulmonary embolism (PE) is a complication of parenteral nutrition (PN) with a prevalence of 35% in children. In 2003 new intravenous lipid emulsions (ILEs) with MCT, olive and/or fish oil in addition to soybean oil were introduced. The aim was to compare the incidence of PE before and after introduction.
  
  
  
  327 surveillance ventilation-perfusion (V/Q) scintigraphies from 68 children aged 0.3-15 years, treated with PN from 1993 to 2010, were retrospectively reviewed. Rate of PE/1000 central venous catheter (CVC) days, number of children with PE pre- and post-introduction of ILEs were compared. Multivariate analyses were performed for risk factors.
  
  
  
  Twenty-two (32%) children (19/42 before 2003 and 3/26 after 2003, p = 0.007) had at least one episode of PE. Thirty seven (11%) episodes of PE were detected accounting for a mean of 0.2/1000 CVC days prior to 2003 and 0.05/1000 CVC days after 2003, p = 0.04. Regression analysis indicated that higher content of ILE/infusion (p = 0.045) and frequency of ILE of >3 nights/week were associated with more PE (p = 0.001). New ILEs were associated with lower risk (p = 0.003).
  
  
  
  With a four-fold fall in incidence with new ILE, PE remains a complication. We recommend 12-18 monthly surveillance with lung perfusion scan and anticoagulants if PE is diagnosed.
authors.affiliation: Department of Paediatric Gastroenterology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, United Kingdom; Department of Paediatric and Adolescent Medicine, Medical University Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria. Electronic address: judith.pichler@meduniwien.ac.at.
authors.forename: Judith
authors.initials: J
authors.lastname: Pichler
authors.affiliation: Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, United Kingdom.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Biassoni
authors.affiliation: Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, United Kingdom.
authors.forename: Marina
authors.initials: M
authors.lastname: Easty
authors.affiliation: Department of Paediatric Gastroenterology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, United Kingdom; Department of Paediatric Gastroenterology, Cruces University Hospital, BioCruces, UPV/EHU, Barakaldo, Spain.
authors.forename: Inaki
authors.initials: I
authors.lastname: Irastorza
authors.affiliation: Department of Paediatric Gastroenterology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, United Kingdom.
authors.forename: Susan
authors.initials: S
authors.lastname: Hill
mesh_terms: D000293:Adolescent; D062905:Central Venous Catheters; D002648:Child; D002675:Child, Preschool; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D000069463:Olive Oil / Q000008:administration & dosage; D010288:Parenteral Nutrition / Q000009:adverse effects*; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D013024:Soybean Oil / Q000008:administration & dosage; D014280:Triglycerides / Q000008:administration & dosage
chemical_list: D005217:Fat Emulsions, Intravenous; D005395:Fish Oils; D000069463:Olive Oil; D014280:Triglycerides; D013024:Soybean Oil
keywords: Children; Intravenous lipid emulsions; Long-term parenteral nutrition; Pulmonary emboli; Ventilation-perfusion scintigraphy