ESPGHAN Committee on Nutrition Position Paper. Intravenous lipid emulsions and risk of hepatotoxicity in infants and children: a systematic review and meta-analysis

Iva Hojsak; Virginie Colomb; Christian Braegger; Jiri Bronsky; Cristina Campoy; Magnus Domellöf; Nicholas Embleton; Nataša Fidler Mis; Jessie M Hulst; Flavia Indrio; Alexandre Lapillonne; Walter Mihatsch; Christian Mølgaard; Johannes van Goudoever; Mary Fewtrell; ESPGHAN Committee on Nutrition

doi:10.1097/MPG.0000000000001121

ESPGHAN Committee on Nutrition Position Paper. Intravenous lipid emulsions and risk of hepatotoxicity in infants and children: a systematic review and meta-analysis

Iva Hojsak, Virginie Colomb, Christian Braegger, Jiri Bronsky, Cristina Campoy, Magnus Domellöf, Nicholas Embleton, Nataša Fidler Mis, Jessie M Hulst, Flavia Indrio, Alexandre Lapillonne, Walter Mihatsch, Christian Mølgaard, Johannes van Goudoever, Mary Fewtrell, ESPGHAN Committee on Nutrition

Lifecourse Nutrition & Health

61 Citations (Scopus)

Abstract

The aim of the present article was to perform a systematic review with meta-analysis of available scientific evidence regarding the role of different intravenous lipid emulsions (ILE) in the pathogenesis of cholestasis and parenteral nutrition-associated liver disease. A systematic review of the literature (up to March 2015) identified 23 randomized controlled trials (RCTs). Of these, 17 were performed in preterm infants or critically ill neonates with a short duration of intervention, 2 in older children with short-term use (following surgery or bone marrow transplantation), 1 in neonates with long-term use, and 3 in infants and children receiving long-term parenteral nutrition (PN). Meta-analysis showed no differences in the rate of cholestasis or bilirubin levels associated with short-term use of different ILEs. Because of high heterogeneity of the long-term studies no meta-analysis could be performed. Available studies found that the use of multicomponent fish oil (FO)-containing ILE compared with pure soya bean oil (SO), ILE-reduced liver enzymes, and bilirubin levels in noncholestatic children on long-term PN and one other RCT found that FO-based ILE-reversed cholestasis in a proportion of patients. The ESPGHAN Committee on Nutrition concludes that there is no evidence of a difference in rates of cholestasis or bilirubin levels between different ILE for short-term use in neonates. The use of multicomponent FO-containing ILE may contribute to a decrease in total bilirubin levels in children with IF on prolonged PN. Well-designed RCTs are, however, lacking and long-term effects have not been determined.

Original language	English
Journal	Journal of Pediatric Gastroenterology and Nutrition
Volume	62
Issue number	5
Pages (from-to)	776-792
Number of pages	17
ISSN	0277-2116
DOIs	https://doi.org/10.1097/MPG.0000000000001121
Publication status	Published - 1 May 2016

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10.1097/MPG.0000000000001121

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Hojsak, I., Colomb, V., Braegger, C., Bronsky, J., Campoy, C., Domellöf, M., Embleton, N., Mis, N. F., Hulst, J. M., Indrio, F., Lapillonne, A., Mihatsch, W., Mølgaard, C., van Goudoever, J., Fewtrell, M., & ESPGHAN Committee on Nutrition (2016). ESPGHAN Committee on Nutrition Position Paper. Intravenous lipid emulsions and risk of hepatotoxicity in infants and children: a systematic review and meta-analysis. Journal of Pediatric Gastroenterology and Nutrition, 62(5), 776-792. https://doi.org/10.1097/MPG.0000000000001121

ESPGHAN Committee on Nutrition Position Paper. Intravenous lipid emulsions and risk of hepatotoxicity in infants and children : a systematic review and meta-analysis. / Hojsak, Iva; Colomb, Virginie; Braegger, Christian et al.

In: Journal of Pediatric Gastroenterology and Nutrition, Vol. 62, No. 5, 01.05.2016, p. 776-792.

Research output: Contribution to journal › Review › peer-review

Hojsak, I, Colomb, V, Braegger, C, Bronsky, J, Campoy, C, Domellöf, M, Embleton, N, Mis, NF, Hulst, JM, Indrio, F, Lapillonne, A, Mihatsch, W, Mølgaard, C, van Goudoever, J, Fewtrell, M & ESPGHAN Committee on Nutrition 2016, 'ESPGHAN Committee on Nutrition Position Paper. Intravenous lipid emulsions and risk of hepatotoxicity in infants and children: a systematic review and meta-analysis', Journal of Pediatric Gastroenterology and Nutrition, vol. 62, no. 5, pp. 776-792. https://doi.org/10.1097/MPG.0000000000001121

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title = "ESPGHAN Committee on Nutrition Position Paper. Intravenous lipid emulsions and risk of hepatotoxicity in infants and children: a systematic review and meta-analysis",

abstract = "The aim of the present article was to perform a systematic review with meta-analysis of available scientific evidence regarding the role of different intravenous lipid emulsions (ILE) in the pathogenesis of cholestasis and parenteral nutrition-associated liver disease. A systematic review of the literature (up to March 2015) identified 23 randomized controlled trials (RCTs). Of these, 17 were performed in preterm infants or critically ill neonates with a short duration of intervention, 2 in older children with short-term use (following surgery or bone marrow transplantation), 1 in neonates with long-term use, and 3 in infants and children receiving long-term parenteral nutrition (PN). Meta-analysis showed no differences in the rate of cholestasis or bilirubin levels associated with short-term use of different ILEs. Because of high heterogeneity of the long-term studies no meta-analysis could be performed. Available studies found that the use of multicomponent fish oil (FO)-containing ILE compared with pure soya bean oil (SO), ILE-reduced liver enzymes, and bilirubin levels in noncholestatic children on long-term PN and one other RCT found that FO-based ILE-reversed cholestasis in a proportion of patients. The ESPGHAN Committee on Nutrition concludes that there is no evidence of a difference in rates of cholestasis or bilirubin levels between different ILE for short-term use in neonates. The use of multicomponent FO-containing ILE may contribute to a decrease in total bilirubin levels in children with IF on prolonged PN. Well-designed RCTs are, however, lacking and long-term effects have not been determined.",

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T1 - ESPGHAN Committee on Nutrition Position Paper. Intravenous lipid emulsions and risk of hepatotoxicity in infants and children

T2 - a systematic review and meta-analysis

AU - Hojsak, Iva

AU - Colomb, Virginie

AU - Braegger, Christian

AU - Bronsky, Jiri

AU - Campoy, Cristina

AU - Domellöf, Magnus

AU - Embleton, Nicholas

AU - Mis, Nataša Fidler

AU - Hulst, Jessie M

AU - Indrio, Flavia

AU - Lapillonne, Alexandre

AU - Mihatsch, Walter

AU - Mølgaard, Christian

AU - van Goudoever, Johannes

AU - Fewtrell, Mary

AU - ESPGHAN Committee on Nutrition

N1 - CURIS 2016 NEXS 109

PY - 2016/5/1

Y1 - 2016/5/1

N2 - The aim of the present article was to perform a systematic review with meta-analysis of available scientific evidence regarding the role of different intravenous lipid emulsions (ILE) in the pathogenesis of cholestasis and parenteral nutrition-associated liver disease. A systematic review of the literature (up to March 2015) identified 23 randomized controlled trials (RCTs). Of these, 17 were performed in preterm infants or critically ill neonates with a short duration of intervention, 2 in older children with short-term use (following surgery or bone marrow transplantation), 1 in neonates with long-term use, and 3 in infants and children receiving long-term parenteral nutrition (PN). Meta-analysis showed no differences in the rate of cholestasis or bilirubin levels associated with short-term use of different ILEs. Because of high heterogeneity of the long-term studies no meta-analysis could be performed. Available studies found that the use of multicomponent fish oil (FO)-containing ILE compared with pure soya bean oil (SO), ILE-reduced liver enzymes, and bilirubin levels in noncholestatic children on long-term PN and one other RCT found that FO-based ILE-reversed cholestasis in a proportion of patients. The ESPGHAN Committee on Nutrition concludes that there is no evidence of a difference in rates of cholestasis or bilirubin levels between different ILE for short-term use in neonates. The use of multicomponent FO-containing ILE may contribute to a decrease in total bilirubin levels in children with IF on prolonged PN. Well-designed RCTs are, however, lacking and long-term effects have not been determined.

AB - The aim of the present article was to perform a systematic review with meta-analysis of available scientific evidence regarding the role of different intravenous lipid emulsions (ILE) in the pathogenesis of cholestasis and parenteral nutrition-associated liver disease. A systematic review of the literature (up to March 2015) identified 23 randomized controlled trials (RCTs). Of these, 17 were performed in preterm infants or critically ill neonates with a short duration of intervention, 2 in older children with short-term use (following surgery or bone marrow transplantation), 1 in neonates with long-term use, and 3 in infants and children receiving long-term parenteral nutrition (PN). Meta-analysis showed no differences in the rate of cholestasis or bilirubin levels associated with short-term use of different ILEs. Because of high heterogeneity of the long-term studies no meta-analysis could be performed. Available studies found that the use of multicomponent fish oil (FO)-containing ILE compared with pure soya bean oil (SO), ILE-reduced liver enzymes, and bilirubin levels in noncholestatic children on long-term PN and one other RCT found that FO-based ILE-reversed cholestasis in a proportion of patients. The ESPGHAN Committee on Nutrition concludes that there is no evidence of a difference in rates of cholestasis or bilirubin levels between different ILE for short-term use in neonates. The use of multicomponent FO-containing ILE may contribute to a decrease in total bilirubin levels in children with IF on prolonged PN. Well-designed RCTs are, however, lacking and long-term effects have not been determined.

U2 - 10.1097/MPG.0000000000001121

DO - 10.1097/MPG.0000000000001121

M3 - Review

C2 - 26825766

SN - 0277-2116

VL - 62

SP - 776

EP - 792

JO - Journal of Pediatric Gastroenterology and Nutrition

JF - Journal of Pediatric Gastroenterology and Nutrition

IS - 5

ER -

ESPGHAN Committee on Nutrition Position Paper. Intravenous lipid emulsions and risk of hepatotoxicity in infants and children: a systematic review and meta-analysis

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