One-year Experience With Composite Intravenous Lipid Emulsion in Children on Home Parenteral Nutrition.
One-year Experience With Composite Intravenous Lipid Emulsion in Children on Home Parenteral Nutrition.
复制标题
儿童复合静脉脂质乳剂家庭肠外营养的一年经验。
DOI：
10.1097/mpg.0000000000003011
复制
发表时间：
2021
影响因子：
2.9
通讯作者：
Puder,Mark
中科院分区：
文献类型：
--
作者：
Raphael,BramP;Mitchell,PaulD;Carey,Alexandra;Gura,KathleenM;Puder,Mark
背景：由大豆油、中链甘油三酯、橄榄油和鱼油组成的复合脂肪乳剂(CLE)在美国被批准用于非肠道喂养的成年人。对于没有胆汁淤积(直接胆红素和GT2.0 mg/dL)的稳定的家庭外营养(HPN)出院的儿童，CLE在理论上比大豆为主的静脉脂肪乳剂有好处，这是因为减少了植物甾醇暴露，并提供了更高的卡路里支持，以允许降低葡萄糖输注率(GIRS)，补充omega-3和补充α-生育酚。方法：在这项前瞻性的单中心开放研究中，评估了18岁以下HPN患者使用CLE治疗的安全性和有效性，剂量为1~3g·kg−，每天1次，−1次，持续12个月。主要结果是与基线相比，人体测量学和GIRS发生了变化。次要结果是与基线相比，脂肪酸谱、肝功能和酶检测的变化。结果：57名受试者的中位年龄为7岁。72%的患者诊断为短肠综合征。实践中的改变与基线后4至6个月及以后的平均GIRS从17 mg·kg−1·h−1下降相关，同时伴随着平均花生四烯酸和稳定的生长参数的下降。未发现明显的不良反应。结论：在服用HPN的1岁稳定儿童中，CLE是安全和耐受性良好的，但需要在这一人群中进行进一步的研究来评估长期结果。
Background:Composite lipid emulsion (CLE) composed of soybean oil, medium-chain triglycerides, olive oil, and fish oil is approved in the US for parenterally fed adults. For stable children discharged on home parenteral nutrition (HPN) without cholestasis (direct bilirubin> 2.0 mg/dL), CLE has theoretical benefits over soybean-based intravenous lipid emulsion due to reduced phytosterol exposure with higher calorie support to permit reduced glucose infusion rates (GIRs), omega-3 supplementation, and supplemental α-tocopherol.Methods:In this prospective, single-center open-label research study, safety and efficacy outcomes were evaluated in patients on HPN younger than 18 years treated with CLE at 1 to 3 g· kg− 1· day− 1 over 12 months. The primary outcome was change in anthropometrics and GIRs compared with baseline. Secondary outcomes were changes in fatty acid profiles and liver function and enzyme tests compared with baseline.Results:Fifty-seven subjects were treated with a median age of 7 years. The diagnosis was short bowel syndrome in 72%. Change in practice was associated with a decrease in mean GIRs from 17 to 14 mg· kg− 1· h− 1 at 4 to 6 months postbaseline and beyond with a coincidental decline in mean arachidonic acid and stable growth parameters. No significant adverse events were noted.Conclusions:CLE was safe and well-tolerated in stable children on HPN at 1 year, but further studies are needed in this population to appreciate long-term outcomes.