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- Title
Change to Mixed-Lipid Emulsion From Soybean Oil–Based Lipid Emulsion in Pediatric Patients.
- Authors
Haines, Krista L.; Ohnuma, Tetsu; Hornik, Chi Dang; Grisel, Braylee; Leraas, Harold; Trujillo, Charles N.; Krishnamoorthy, Vijay; Raghunathan, Karthik; Wischmeyer, Paul E.
- Abstract
This cohort study evaluates outcomes of switching from soybean oil–based lipid emulsion to mixed-lipid emulsion parenteral nutrition in pediatric patients. Key Points: Question: Does switching from soybean oil–based lipid emulsion (Intralipid) to a mixed-lipid formula (4-OLE) improve outcomes in pediatric patients who were parenteral nutrition (PN)–dependent? Findings: In this cohort study of 684 children who were PN-dependent, 4-OLE was associated with a statistically significant shorter hospital length of stay in the all children and ICU cohorts. Meaning: These findings suggest that switching to 4-OLE parenteral nutrition formula over soybean oil–based lipid emulsion may lead to improved outcomes in pediatric patients. Importance: Critically ill pediatric patients often require parenteral nutrition (PN) in the intensive care unit (ICU). Literature suggests mixed lipid emulsions (LE) with soybean oil reduction strategies may improve outcomes. Objective: To examine the association of a hospital-wide switch to a mixed-lipid formula (4-OLE) with pediatric outcomes. Design, Setting, and Participants: Retrospective cohort study at a large US academic referral center. Pediatric patients aged 1 month to 17 years requiring parenteral nutrition from May 2016 to September 2019 were included. Data were analyzed from October 2020 to February 2023. Exposure: In 2017, Duke University Health System fully converted to a soybean oil/MCT/olive/fish oil lipid (4-OLE) from pure soybean oil–based LE in pediatric patients. Pediatric patients before the change (Intralipid [IL] group) were compared with patients after (4-OLE group). Main Outcomes and Measures: Clinical outcomes were compared between treatment periods via multivariable regression models. The primary outcome was hospital length of stay (LOS). Fourteen secondary outcomes included hospital mortality of any cause, 30-day or 90-day readmission, pneumonia, urinary tract infections (UTIs), total caloric delivery, and liver function tests (aspartate aminotransferase, alanine transaminase, alkaline phosphatase, and total bilirubin). Results: A total of 684 children dependent on PN were identified (342 were critically ill), with 30% (206 children) in the preswitch (IL) period and 70% (478 children) in the postswitch (4-OLE) period; 123 were male (59.7%). In comparing IL vs 4-OLE, there was a significant difference in median (IQR) age (4.0 [1.2-13.0] vs 3.0 [0.8-9.0] years, respectively; P =.04), without difference in body mass index or baseline comorbidities except for significant differences in cancer diagnosis (26 patients in the IL group [12.6%] vs 29 patients in the 4-OLE group [6.1%]; P =.004) and chronic obstructive pulmonary disease (24 patients in the IL group [11.7%] vs 30 patients in the 4-OLE group [6.3%]; P =.02). In the all children cohort, 4-OLE was associated with shorter hospital LOS (IRR, 0.81; 95% CI, 0.05-0.78), and reduced UTI risk (OR, 0.33; 95% CI, 0.18-0.64). In the ICU cohort, 4-OLE was associated with shorter hospital LOS (IRR, 0.81; 95% CI, 0.78-0.83), and reduced UTI risk (OR, 0.23; 95% CI, 0.11-0.51). Other secondary outcomes were not significant. Conclusions and Relevance: In this observational study of clinical outcomes among children dependent on PN, a switch to 4-OLE in a large academic hospital was associated with a significant decrease in hospital LOS in ICU and non-ICU patients. These findings suggest switching to a soy–LE sparing strategy using 4-OLE is feasible, safe, and associated with improved clinical outcomes in pediatric PN patients.
- Subjects
LENGTH of stay in hospitals; ALKALINE phosphatase; CONFIDENCE intervals; MULTIVARIATE analysis; MULTIPLE regression analysis; PEDIATRICS; RETROSPECTIVE studies; CATASTROPHIC illness; TREATMENT effectiveness; HOSPITAL mortality; SOY oil; DESCRIPTIVE statistics; RESEARCH funding; INTRAVENOUS fat emulsions; PARENTERAL feeding; ODDS ratio; LONGITUDINAL method; ASPARTATE aminotransferase; ALANINE aminotransferase; BILIRUBIN
- Publication
JAMA Network Open, 2023, Vol 6, Issue 9, pe2332389
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.32389