A Comparison of Smoflipid® and Intralipid® in the Early Management of Infants with Intestinal Failure

Cameron Casson, Van Nguyen, Pritha Nayak, Nandini Channabasappa, Kaitlin Berris, Julia Panczuk, Cyrus Bhiladvala, Tisha Dasgupta, Hannah G. Piper

Research output: Contribution to journalArticle

Abstract

Purpose: Cholestasis is problematic for infants with intestinal failure (IF). The soy-based lipid Intralipid® (IL) has been implicated. An alternative, Smoflipid® (SMOF), is increasingly used. However, its role in cholestasis prevention is unclear. This study compares the incidence and degree of cholestasis between infants with IF receiving SMOF or IL. Methods: Infants with IF receiving SMOF or IL during the first 8 weeks of parenteral nutrition (PN) support between 2014 and 2017 were reviewed. Clinical characteristics, cholestasis incidence (conjugated bilirubin (Cbili) > 2 mg/dL for > 2 weeks), and nutritional parameters were compared using Welch's t-test. Results: 91% (21/23) of IL and 76% (16/21) of SMOF babies became cholestatic (p = 0.18). There was no significant difference in median peak Cbili, but SMOF babies normalized more quickly (p = 0.04). Median z-scores for weight were similar throughout the study. SMOF patients getting full PN had a lower incidence of cholestasis compared to IL patients (78% vs. 92%, p = 0.057), but those with cholestasis had similar peak Cbili, time to resolution, and growth. Conclusion: Early use of Smoflipid® did not reduce the incidence of cholestasis compared to Intralipid® in infants with IF, but hyperbilirubinemia did resolve more quickly. SMOF may be most beneficial for infants tolerating no enteral nutrition. Level of Evidence: Level III Retrospective Comparative Treatment Study. Type of Study: Retrospective Review.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Cholestasis
Bilirubin
Parenteral Nutrition
Incidence
Hyperbilirubinemia
Enteral Nutrition
phospholipid emulsion soybean oil
Cohort Studies
Retrospective Studies
Lipids
Weights and Measures
Growth

Keywords

  • Cholestasis
  • Intestinal failure-associated liver disease
  • Lipid emulsion

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

A Comparison of Smoflipid® and Intralipid® in the Early Management of Infants with Intestinal Failure. / Casson, Cameron; Nguyen, Van; Nayak, Pritha; Channabasappa, Nandini; Berris, Kaitlin; Panczuk, Julia; Bhiladvala, Cyrus; Dasgupta, Tisha; Piper, Hannah G.

In: Journal of Pediatric Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Casson, Cameron ; Nguyen, Van ; Nayak, Pritha ; Channabasappa, Nandini ; Berris, Kaitlin ; Panczuk, Julia ; Bhiladvala, Cyrus ; Dasgupta, Tisha ; Piper, Hannah G. / A Comparison of Smoflipid® and Intralipid® in the Early Management of Infants with Intestinal Failure. In: Journal of Pediatric Surgery. 2019.
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abstract = "Purpose: Cholestasis is problematic for infants with intestinal failure (IF). The soy-based lipid Intralipid{\circledR} (IL) has been implicated. An alternative, Smoflipid{\circledR} (SMOF), is increasingly used. However, its role in cholestasis prevention is unclear. This study compares the incidence and degree of cholestasis between infants with IF receiving SMOF or IL. Methods: Infants with IF receiving SMOF or IL during the first 8 weeks of parenteral nutrition (PN) support between 2014 and 2017 were reviewed. Clinical characteristics, cholestasis incidence (conjugated bilirubin (Cbili) > 2 mg/dL for > 2 weeks), and nutritional parameters were compared using Welch's t-test. Results: 91{\%} (21/23) of IL and 76{\%} (16/21) of SMOF babies became cholestatic (p = 0.18). There was no significant difference in median peak Cbili, but SMOF babies normalized more quickly (p = 0.04). Median z-scores for weight were similar throughout the study. SMOF patients getting full PN had a lower incidence of cholestasis compared to IL patients (78{\%} vs. 92{\%}, p = 0.057), but those with cholestasis had similar peak Cbili, time to resolution, and growth. Conclusion: Early use of Smoflipid{\circledR} did not reduce the incidence of cholestasis compared to Intralipid{\circledR} in infants with IF, but hyperbilirubinemia did resolve more quickly. SMOF may be most beneficial for infants tolerating no enteral nutrition. Level of Evidence: Level III Retrospective Comparative Treatment Study. Type of Study: Retrospective Review.",
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AU - Casson, Cameron

AU - Nguyen, Van

AU - Nayak, Pritha

AU - Channabasappa, Nandini

AU - Berris, Kaitlin

AU - Panczuk, Julia

AU - Bhiladvala, Cyrus

AU - Dasgupta, Tisha

AU - Piper, Hannah G.

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N2 - Purpose: Cholestasis is problematic for infants with intestinal failure (IF). The soy-based lipid Intralipid® (IL) has been implicated. An alternative, Smoflipid® (SMOF), is increasingly used. However, its role in cholestasis prevention is unclear. This study compares the incidence and degree of cholestasis between infants with IF receiving SMOF or IL. Methods: Infants with IF receiving SMOF or IL during the first 8 weeks of parenteral nutrition (PN) support between 2014 and 2017 were reviewed. Clinical characteristics, cholestasis incidence (conjugated bilirubin (Cbili) > 2 mg/dL for > 2 weeks), and nutritional parameters were compared using Welch's t-test. Results: 91% (21/23) of IL and 76% (16/21) of SMOF babies became cholestatic (p = 0.18). There was no significant difference in median peak Cbili, but SMOF babies normalized more quickly (p = 0.04). Median z-scores for weight were similar throughout the study. SMOF patients getting full PN had a lower incidence of cholestasis compared to IL patients (78% vs. 92%, p = 0.057), but those with cholestasis had similar peak Cbili, time to resolution, and growth. Conclusion: Early use of Smoflipid® did not reduce the incidence of cholestasis compared to Intralipid® in infants with IF, but hyperbilirubinemia did resolve more quickly. SMOF may be most beneficial for infants tolerating no enteral nutrition. Level of Evidence: Level III Retrospective Comparative Treatment Study. Type of Study: Retrospective Review.

AB - Purpose: Cholestasis is problematic for infants with intestinal failure (IF). The soy-based lipid Intralipid® (IL) has been implicated. An alternative, Smoflipid® (SMOF), is increasingly used. However, its role in cholestasis prevention is unclear. This study compares the incidence and degree of cholestasis between infants with IF receiving SMOF or IL. Methods: Infants with IF receiving SMOF or IL during the first 8 weeks of parenteral nutrition (PN) support between 2014 and 2017 were reviewed. Clinical characteristics, cholestasis incidence (conjugated bilirubin (Cbili) > 2 mg/dL for > 2 weeks), and nutritional parameters were compared using Welch's t-test. Results: 91% (21/23) of IL and 76% (16/21) of SMOF babies became cholestatic (p = 0.18). There was no significant difference in median peak Cbili, but SMOF babies normalized more quickly (p = 0.04). Median z-scores for weight were similar throughout the study. SMOF patients getting full PN had a lower incidence of cholestasis compared to IL patients (78% vs. 92%, p = 0.057), but those with cholestasis had similar peak Cbili, time to resolution, and growth. Conclusion: Early use of Smoflipid® did not reduce the incidence of cholestasis compared to Intralipid® in infants with IF, but hyperbilirubinemia did resolve more quickly. SMOF may be most beneficial for infants tolerating no enteral nutrition. Level of Evidence: Level III Retrospective Comparative Treatment Study. Type of Study: Retrospective Review.

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KW - Intestinal failure-associated liver disease

KW - Lipid emulsion

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