A Comparison of Smoflipid® and Intralipid® in the Early Management of Infants with Intestinal Failure
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Read the article on jpedsurg.org ↗Article · Oct 2019 · 1 min read
In brief
In brief
Retrospective study comparing Smoflipid® versus Intralipid® lipid emulsions in 44 infants with intestinal failure found no significant difference in cholestasis incidence (76% vs 91%), but Smoflipid patients resolved hyperbilirubinemia faster. Smoflipid may offer greatest benefit for infants unable to tolerate enteral feeds.
Written by the GCMD Library team from the article.
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.