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Resolution of Parenteral Nutrition–associated Jaundice on Changing From a Soybean Oil Emulsion to a Complex Mixed-Lipid Emulsion

Muhammed, Rafeeq*; Bremner, Ronald*; Protheroe, Sue*; Johnson, Tracey; Holden, Chris; Murphy, M. Stephen§

Journal of Pediatric Gastroenterology and Nutrition: June 2012 - Volume 54 - Issue 6 - p 797–802
doi: 10.1097/MPG.0b013e3182447daf
Original Articles: Hepatology and Nutrition

Background and Objective: Resolution of parenteral nutrition (PN)–associated jaundice has been reported in children given a reduced dose of intravenous fat using a fish oil–derived lipid emulsion. The aim of the present study was to examine the effect on PN-associated jaundice of changing from a soybean oil–derived lipid to a mixed lipid emulsion derived from soybean, coconut, olive, and fish oils without reducing the total amount of lipid given.

Methods: Retrospective cohort comparison examining serum bilirubin during 6 months in children with PN-associated jaundice who changed to SMOFlipid (n = 8) or remained on Intralipid (n = 9).

Results: At entry, both groups received most of their energy as PN (SMOFlipid 81.5%, range 65.5–100 vs Intralipid 92.2%, range 60.3–100; P = 0.37). After 6 months, both tolerated increased enteral feeding but still received large proportions of their energy as PN (SMOFlipid 68.4%, range 36.6–100 vs Intralipid 50%, range 37.6–76; P = 0.15). The median bilirubin at the outset was 143 μmol/L (range 71–275) in the SMOFlipid group and 91 μmol/L (range 78–176) in the Intralipid group. After 6 months, 5 of 8 children in the SMOFlipid and 2 of 9 children in the Intralipid group had total resolution of jaundice. The median bilirubin fell by 99 μmol/L in the SMOFlipid group but increased by 79 μmol/L in the Intralipid group (P = 0.02).

Conclusions: SMOFlipid may have important protective properties for the liver and may constitute a significant advance in PN formulation. Randomised trials are needed to study the efficacy of SMOFlipid in preventing PN liver disease.

*Department of Paediatric Gastroenterology

Department of Dietetics

Nutritional Care Team, Birmingham Children's Hospital NHS Foundation Trust

§School of Clinical and Experimental Medicine, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.

Address correspondence and reprint requests to Dr M. Stephen Murphy, Institute of Child Health, Clinical Research Block, Whittall St, Birmingham, B4 6NH, UK (e-mail:

Received 20 January, 2011

Accepted 26 September, 2011

Copyright 2012 by ESPGHAN and NASPGHAN