Association between multioil intravenous lipid emulsion and cholestasis in infants with gastrointestinal disorders: A retrospective cohort study.

Background: Infants with gastrointestinal (GI) disorders are at risk for parenteral nutrition-associated cholestasis. A multioil intravenous lipid emulsion (MO ILE) contains less phytosterols and more arachidonic and docosahexaenoic acid (DHA) than 100% soybean oil lipid emulsion (SO ILE). This study compares parenteral nutrition-associated cholestasis, growth, and fatty acids in infants with GI disorders who received MO ILE or SO ILE.

Methods: This retrospective cohort study included 48 infants with GI disorders born between 2014 and 2022 who received an intravenous lipid emulsion for ≥14 days. Cholestasis was defined as serum conjugated bilirubin ≥2 mg/dl; growth was assessed by z score changes. Gas chromatography and mass spectrometry was used to measure fatty acid content in the erythrocyte cell membrane.

Results: The incidence of parenteral nutrition-associated cholestasis was similar (MO ILE 30% vs SO ILE 29%, P > 0.99). However, compared with infants who received parenteral nutrition >28 days and SO ILE, infants who received parenteral nutrition >28 days and MO ILE experienced a slower rise in conjugated bilirubin (0.1 ± 0.03 vs 0.26 ± 0.38 mg/dl, P interaction < 0.001). Weight z score decline (discharge to birth) was less in the MO ILE group vs SO ILE group (-1.0 [-2.0, -0.4] vs -0.4 [-0.9, 0], P = 0.04). Although the MO ILE group demonstrated improved DHA status at weeks 1-3 (P < 0.05 for all), arachidonic acid and DHA decreased over time in both groups and there was no difference in the rate of change (P interaction > 0.3 for both).

Conclusion: In infants with GI disorders, MO ILE was associated with improved growth. MO ILE was well tolerated and hepatoprotective in infants who required prolonged parenteral nutrition.