Intravenous lipid emulsions in pediatric patients with intestinal failure

The incidence of cholestatic liver disease ( CLD) in pediatric patients suffering intestinal failure ( IF) is not well established. Due to persistent portal inflammation, about 20% of these patients will progress to end-stage intestinal failure associated liver disease ( IFALD) leading to liver transplant or death. Purpose of review Premature babies as well as infants with short bowel syndrome ( SBS) and repeated sepsis ( catheter or small intestinal bacterial overgrowth related) are at risk of developing CLD. Clinical data in SBS infants focused on intravenous lipid emulsion ( ILE) as an important factor of CLD. Recent findings Compared to the last generation of composite ILE containing fish oil ( FO), soybean oil ( SO) based ILE, have marked differences in term of oil source, omega-3 fatty acids ( FAs) composition, vitamin E ( alpha-tocopherols) and plant sterols contents, that may explain CLD and CLD reversal. Randomized controlled trials and meta-analysis allow the following recommendations. Summary In pediatric patients with developing or established CLD or IFALD, potential causes should be explored and pure SO ILE should be avoided. A reduction of the ILE dosage and/or the use of the new composite FO based ILE, may be recommended along with the treatment and management of other risk factors. The 10% pure FO ILE should not be used as a sole provision of IV lipids in paediatric patients on total PN but can only serve as a short-term rescue treatment.