A comparison of lipid minimization strategies in children with intestinal failure

Purpose: The purpose of this study was to compare outcomes of lipid minimization with either Intralipid (IL) or Omegaven® in children with intestinal failure (IF) who developed intestinal failure-associated liver disease (IFALD) while receiving parenteral nutrition (PN). Methods: A retrospective review of children with IF requiring PN who developed IFALD (direct bilirubin > 2 mg/dL) while receiving IL (2009–2016) was performed. Clinical characteristics, nutritional, and laboratory values were compared between children treated with reduced IL or Omegaven®. Results: 16 children were reviewed (8 treated with IL and 8 treated with Omegaven® at a median dose of 1g/kg/d). Both groups had similar demographics, small bowel length, and parenteral nutritional intake during the study (82.9 ± 27.1 kcal/kg/d vs. 75.9 ± 16.5 kcal/kg/d, p = 0.54). The mean direct bilirubin (DBili) prior to initiating treatment was 7.8 ± 4.3 mg/dL and 7.5 ± 3.5 mg/dL (p = 0.87) in the IL and Omegaven® groups, respectively. The IL group took a median of 113 days to achieve a DBili < 0.5 mg/dL compared to 124 days in the Omegaven® group (p = 0.49). There were no differences in markers of liver function or growth trajectories among groups. Conclusions: Lipid minimization with either IL or Omegaven® has similar success in achieving a normal DBili in children with IF and IFALD without major differences in nutritional status or growth. Type of study: Treatment Study Level of evidence: III.