• Liver Function in Pediatric Recipients: A Comparison of Intralipid and Smoflipid

      Daniel, Shawnée; Svoboda, Leanne; Chen, Justin (Pediatric Pharmacy Advocacy Group, Inc., 2021-03-31)
      OBJECTIVES An adverse consequence of primarily soybean oil–based parenteral nutrition is the development of intestinal failure–associated liver disease (IFALD), defined as bilirubin ≥ 2 mg/dL. Fish oil– containing lipid emulsion products, such as soybean oil, medium-chain triglycerides, olive oil, fish oil lipid injectable emulsion (SMOF-ILE), have been shown to be beneficial in patients at risk of developing IFALD. This study aimed to review the safety profile of SMOF-ILE and soybean oil–based lipid injectable emulsion (SO-ILE) in regard to liver function and cholestasis in the pediatric and neonatal population. METHODS A retrospective review was performed for patients who received SO-ILE or SMOF-ILE over a 3-year period. Patients < 18 years of age who received at least 2 weeks of either product were included. The primary endpoints were 2 consecutive bilirubin readings ≥ 2 mg/dL that were separated by at least 1 week and time to first bilirubin ≥ 2 mg/dL. Secondary endpoints included assessment of select laboratory values (i.e., aspartate aminotransferase, alanine aminotransferase, triglycerides, serum creatinine, serum sodium, coagulation laboratory test, albumin) up to 6 months while on intravenous lipid products. Ursodiol use and mortality were also noted. RESULTS There was a higher prevalence of IFALD in pediatric patients receiving SO-ILE than those who received SMOF-ILE (32% vs 12%, p = 0.03). There was no detectable difference in the time it took for IFALD to develop (19 days vs 15 days, p = 0.08). CONCLUSION In our cohort of pediatric and neonatal patients, the incidence of IFALD was higher with SOILE than with SMOF-ILE. ABBREVIATIONS ALT, alanine aminotransferase, AST, aspartate aminotransferase, EFAD, essential fatty acid deficiency, FDA, US Food and Drug Administration, GI, gastrointestinal, IFALD, intestinal failure–associated liver disease, ILEs, lipid injectable emulsions, INR, international normalized ratio, NICU, neonatal intensive care unit, PN, parenteral nutrition, SMOF-ILE, soybean oil, medium-chain triglycerides, olive oil, fish oil lipid injectable emulsion, SO-ILE, soybean oil–based lipid injectable emulsion. © Pediatric Pharmacy Association. All rights reserved.