Balık Yağı İçeren veya Zeytinyağından Zengin Parenteral Lipid Emülsiyonu Alan Prematüre Yenidoğanların Karaciğer Fonksiyon Testlerinin Değerlendirilmesi

Yıl 2018, Cilt: 12 Sayı: 2, 124 - 130, 01.08.2018

Sezin Ünal Dilek Ulubaş Işık İlter Arifoğlu Sara Erol Nihal Demirel Ahmet Yağmur Baş

Öz

Amaç: Çalışmada balık yağı içeren veya zeytinyağından zengin lipid parenteral emülsiyonu alan çok düşük doğum ağırlıklı prematüre yenidoğanların karaciğer fonksiyon testleri, kolesterol ve trigliserit düzeylerinin incelenmesi amaçlandı.Gereç ve Yöntemler: Bu retrospektif çalışma Ankara Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi yenidoğan yoğun bakım ünitesinde yapıldı. 01.01.2015 – 31.12.2015 tarihleri arasında hastanemizde doğan, gestasyon haftası 25 – 32 hafta ve doğum ağırlığı 1500 gr’dan küçük olan prematüre yenidoğanların dosyaları incelendi. On gün ve daha fazla parenteral nütrisyon alan ve postnatal 28. gününde yaşayan olgular çalışmaya alındı. Olgular almış oldukları parenteral lipid emülsiyonuna göre (balık yağı içeren; SMOFlipid®, zeytinyağından zengin; ClinOleic®) iki gruba ayrıldı. Üçüncü hafta içerisindeki alanın aminotransferaz, aspartat aminotransferaz, total ve direkt bilirubin, protein, albümin, kalsiyum, fosfor, alkalen fosfataz, kolesterol ve trigliserit düzeyleri kaydedildi ve lipid emülsiyonu türüne göre karşılaştırıldı. Sonuçlar n (%) ve ortanca (çeyrekler arası aralık) olarak sunuldu.Bulgular: Çalışma grubunu 76 prematüre yenidoğan oluşturdu (SMOFlipid grubu: 37 olgu ve ClinOleic grubu: 39 olgu). İki gruptaki olguların gestasyon haftası [hafta; SMOFlipid grubu: 28 (27 – 30), ClinOleic grubu: 28 (27 – 29); p=0.477] ve doğum ağırlığı [gram; SMOFlipid grubu: 1080 (840 – 1290), ClinOleic grubu: 850 (1000 – 1230); p=0.454] benzer idi. Parenteral nütrisyon tedavisi süresi iki grupta farklı saptanmadı [gün; SMOFlipid grubu: 11 (10 – 14), ClinOleic grubu: 12 (10 – 19); p=0.217]. Serum alanin aminotransferaz [U/L; SMOFlipid grubu: 9 (7 – 11), ClinOleic grubu: 10 (7 – 12); p=0.742] ve aspartat aminotransferaz [U/L; SMOFlipid grubu: 24 (18 – 28), ClinOleic grubu: 25 (20 – 31); p=0.365] dahil olmak üzere karaciğer fonksiyon testleri, kolesterol ve trigliserit düzeyleri iki grupta benzer bulundu. Kolestaz SMOFlipid grubunda bir olguda (%3) ve ClinOleic grubunda üç olguda (%8) gelişti, p: 0.330.Sonuç: Bu çalışmada prematüre yenidoğanların parenteral nütrisyon tedavisinde balık yağı içeren veya zeytinyağından zengin lipid emülsiyonların kullanılmasının karaciğer fonksiyon testlerini farklı etkilemedikleri saptandı.

Anahtar Kelimeler

İntavenöz lipid emülsiyonu, Karaciğer fonksiyon testi, Omega-3 yağ asiti, Parenteral beslenme, Prematüre yenidoğan

Evaluation of Liver Function Tests in Preterm Infants Receiving Parenteral Lipid Emulsions Based on Fish Oil or Olive Oil

Öz

Objective: We aimed to compare the serum liver function tests, cholesterol and triglyceride levels in preterm infants receiving parenteral lipid emulsions based on fish oil or olive oil.Material and Methods: This retrospective study was performed at Etlik Zübeyde Hanım Women’s Health Training Hospital, Ankara. We reviewed charts of inborn infants, with a gestational age between 25 and 32 weeks and birth weight <1500 grams, who were admitted to the neonatal intensive care unit between 01.01.2015 and 31.12.2015. Infants who received parenteral nutrition ≥ 10 days and were alive on the 28th day were included and grouped regarding the type of lipid emulsion (fish-oil; SMOFlipid®, olive oil; ClinOleic®). The levels of serum alanine transaminase, aspartate transaminase, total and direct bilirubin, protein, albumin, calcium, phosphorus, alkaline phosphatase, cholesterol, and triglyceride at the third postnatal week were recorded and compared between the groups. Results are presented as n (%) and median (interquartile range) where appropriate.Results: 76 preterm neonates (SMOFlipid group: n=37 and ClinOleic group: n=39) were included. The gestational age [weeks; SMOFlipid group: 28 (27–30), ClinOleic group: 28 (27–29); p=0.477] and birth weight [gram; SMOFlipid group: 1080 (840–1290), ClinOleic group: 850 (1000–1230); p:0.454] were similar in the groups. The duration of parenteral nutrition was comparable [days; SMOFlipid group: 11 (10–14), ClinOleicgroup: 12 (10–19); p=0.217]. The serum alanine transaminase [U/L; SMOFlipid group: 9 (7–11), ClinOleic group: 10 (7–12); p=0.742] and aspartate transaminase [U/L; SMOFlipid group: 24 (18–28), ClinOleic group: 25 (20–31); p=0.365] as well as other biochemical tests were similar between two groups. Cholestasis occurred in four infants [ClinOleic group: 3 (8%), SMOFlipid group: 1 (3%), p=0.330].Conclusion: It was demonstrated that liver function tests and levels of cholesterol and triglyceride were not affected in infants who had received parenteral lipid emulsions based on fish oil or olive oil

Anahtar Kelimeler

Intravenous fat emulsion, Liver Function Tests, Omega-3 fatty acids, Parenteral nutrition, Premature infants

Kaynakça

• 1. Satrom K, Gourley G. Cholestasis in preterm Infants. Clin Perinatol 2016;43:355-73.
• 2. Beale EF, Nelson RM, Bucciarelli RL, Donnelly WH, Eitzman DV. Intrahepatic cholestasis associated with parenteral nutrition in premature infants. Pediatrics 1979;64:342-7
• 3. Christensen RD, Henry E, Wiedmeier SE, Burnett J, Lambert DK. Identifying patients, on the first day of life, at high-risk of developing parenteral nutrition-associated liver disease. J Perinatol 2007;27:284-90.
• 4. Xu ZW, Li YS. Pathogenesis and treatment of parenteral nutrition-associated liver disease. Hepatobiliary Pancreat Dis Int 2012;11:586-93.
• 5. Kim AY, Lim RK, Han YM, Park KH, Byun SY. Parenteral nutritionassociated cholestasis in very low birth weight infants: A single center experience. Pediatr Gastroenterol Hepatol Nutr 2016;19:61- 70.
• 6. Deshpande G, Simmer K, Deshmukh M, Mori TA, Croft KD, Kristensen J. Fish Oil (SMOFlipid) and olive oil lipid (Clinoleic) in very preterm neonates. J Pediatr Gastroenterol Nutr 2014;58:177-82.
• 7. Deshpande GC, Simmer K, Mori T, Croft K. Parenteral lipid emulsions based on olive oil compared with soybean oil in preterm (<28 weeks’ gestation) neonates: A randomised controlled trial. J Pediatr Gastroenterol Nutr 2009;49:619-25.
• 8. Vlaardingerbroek H, Vermeulen MJ, Carnielli VP, Vaz FM, van den Akker CH, van Goudoever JB. Growth and fatty acid profiles of VLBW infants receiving a multicomponent lipid emulsion from birth. J Pediatr Gastroenterol Nutr 2014;58:417-27.
• 9. Weinberger B, Watorek K, Strauss R, Witz G, Hiatt M, Hegyi T. Association of lipid peroxidation with hepatocellular injury in preterm infants. Crit Care 2002;6:521-5.
• 10. Köşger P, Özer E, Helvacı M. Preterm bebeklerde total parenteral beslenme ile ilişkili komplikasyonların sıklığı ve risk faktörleri. J Pediatr Res 2016;3:149-53.
• 11. Tomsits E, Pataki M, Tolgyesi A, Fekete G, Rischak K, Szollar L. Safety and efficacy of a lipid emulsion containing a mixture of soybean oil, medium-chain triglycerides, olive oil, and fish oil: A randomised, double-blind clinical trial in premature infants requiring parenteral nutrition. J Pediatr Gastroenterol Nutr 2010;51:514-21.
• 12. D’Ascenzo R, Savini S, Biagetti C, Bellagamba MP, Marchionni P, Pompilio A, et al. Higher docosahexaenoic acid, lower arachidonic acid and reduced lipid tolerance with high doses of a lipid emulsion containing 15% fish oil: A randomized clinical trial. Clin Nutr 2014;33:1002-9.
• 13. Krawinkel MB. Parenteral nutrition-associated cholestasis-what do we know, what can we do? Eur J Pediatr Surg 2004;14:230-4.
• 14. Albers MJ, de Gast-Bakker DA, van Dam NA, Madern GC, Tibboel D. Male sex predisposes the newborn surgical patient to parenteral nutrition-associated cholestasis and to sepsis. Arch Surg 2002;137:789-93.
• 15. Unal S, Demirel N, Erol S, Isik DU, Kulali F, Iyigun F, et al. Effects of two different lipid emulsions on morbidities and oxidant stress statuses in preterm infants: An observational study. J Matern Fetal Neonatal Med 2017:1-7.
• 16. Rayyan M, Devlieger H, Jochum F, Allegaert K. Short-term use of parenteral nutrition with a lipid emulsion containing a mixture of soybean oil, olive oil, medium-chain triglycerides, and fish oil: A randomized double-blind study in preterm infants. JPEN J Parenter Enteral Nutr 2012;36:81s-94s.
• 17. Goulet O, Antebi H, Wolf C, Talbotec C, Alcindor LG, Corriol O, et al. A new intravenous fat emulsion containing soybean oil, mediumchain triglycerides, olive oil, and fish oil: A single-center, doubleblind randomized study on efficacy and safety in pediatric patients receiving home parenteral nutrition. JPEN J Parenter Enteral Nutr 2010;34:485-95.
• 18. Lacaille F, Gupte G, Colomb V, D’Antiga L, Hartman C, Hojsak I, et al. Intestinal failure-associated liver disease: A position paper of the ESPGHAN Working Group of Intestinal Failure and Intestinal Transplantation. J Pediatr Gastroenterol Nutr 2015;60:272-83.
• 19. Goulet OJ. Intestinal failure-associated liver disease and the use of fish oil-based lipid emulsions. World Rev Nutr Diet 2015;112:90- 114.
• 20. Waitzberg DL, Torrinhas RS, Jacintho TM. New parenteral lipid emulsions for clinical use. JPEN J Parenter Enteral Nutr 2006;30:351-67.
• 21. Park HW, Lee NM, Kim JH, Kim KS, Kim SN. Parenteral fish oil-containing lipid emulsions may reverse parenteral nutritionassociated cholestasis in neonates: A systematic review and metaanalysis. J Nutr 2015;145:277-83.