Comparison of liver function with two new/mixed intravenous lipid emulsions in children with intestinal failure

BACKGROUND/OBJECTIVE: The high incidence of liver disease associated with intravenous soybean lipid has led to development and use of alternative intravenous lipid emulsions (ILEs). The aim of this study was to compare two new/mixed ILEs: a medium-chain triglyceride (MCT) combined with soybean (i.e., Lipofundin) and a combination of both these lipids with additional olive and fish oils (SMOF). SUBJECTS/METHODS: Neonates/premature infants newly starting parenteral nutrition (PN) treatment and children with abnormal liver function tests, alanine transferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (gamma-GT) 1.5x upper limit of normal and/or total bilirubin >50 mu mol/l for >2 weeks on treatment with PN containing pure soybean ILE (Intralipid 20%; Fresenius Kabi), were started on/changed to either SMOF or Lipofundin. Results of biochemistry and clinical outcome were compared on commencing and discontinuing treatment according to the new ILE used. RESULTS: One hundred and twenty-seven children aged 0-16 (median 0.6) years were included. Fifity-six were given Lipofundin and 71 SMOF. Fifty-three of 127 started PN for the first time and 74 had had previous treatment with Intralipid. During treatment, ALT and ALP levels fell significantly (P < 0.008 on SMOF; P < 0.05 on Lipofundin), with additional significant reduction in y-GT with SMOF. Hyperbilirubinaemia incidence decreased from 34% on starting to 24% on discontinuing treatment (P <= 0.05). Infection rate/1000 catheter days, full blood count, serum triglyceride and cholesterol levels were similar with both ILEs. CONCLUSION: Addition of MCT to soybean ILE was associated with improved liver function. There was an even greater improvement when olive and fish oils were also added with higher incidence of resolution of abnormal liver function tests and reduced inflammation.