Comparison of the effects of fish oil containing multicomponent and standard lipid emulsion on parenteral nutrition associated cholestasis.

Öz

Objective: To compare the effect of a multicomponent parenteral lipid emulsion (PLE) with a standard PLE in case of cholestasis induced by long-term use of parenteral nutrition (PN) in infants who need surgical procedures.

Material and Method: We conducted a retrospective study in neonatal intensive care unit (NICU) between January 2011 and February 2012. The patients with surgical procedures and need for long-term PN (at least 2 weeks) at NICU were enrolled in the study. Group 1: given standard lipid emulsion, in addition to the standard treatment of cholestasis, Group 2: given multicomponent lipid emulsion (soybean oil, medium chain triglyceride, olive and lipid fish oil) in addition to the standard treatment of cholestasis. Period of cholestasis and prognosis data were compared during follow-up in NICU.

Results: A total of 24 patients (Group 1 (n = 11) and Group 2 (n = 13)) were included in the study. Period of cholestasis were similar between groups. Despite the inequality between gestational age and birthweight among groups (gestational age 36±4.3 and 30.3±3.4 weeks and p=0,047, birth weight mean 2395±635 and 1404 ±670 g, p=0.03 , respectively Group 1 and 2), total non-feeding time (Group 1: 10 ± 3.3 days; Group 2: 16.3 ± 10.6 days) and total duration of PN (group 1: 20 ± 4.6 days; Group 2: 25.8 ± 17 days) and mortality rates were compared between the groups and there was no statistically difference. There were no short-term adverse effects identified due to the use of multi-component PLE.

Conclusion: No additional contribution of multicomponent PLE than standard PLE to the treatment of cholestasis could be shown at our study. We think that inequality among groups may effect these results.

Anahtar Kelimeler

• Parenteral nutrition
• cholestasis
• surgical case
• multi component lipid emulsion

Balık yağı içeren çok bileşenli ile standart lipid emülsiyonlarının parenteral nutrisyon ilişkili kolestaz üzerine etkilerinin karşılaştırılması.

Öz

Amaç: Yenidoğan döneminde özellikle cerrahi işlem ihtiyacı duyan, uzun süre parenteral beslenme (PB) kullanımına bağlı kolestaz gelişen olgularda standart tedaviye ek olarak verilen balık yağı içeren çok bileşenli ile standart lipid emülsiyonlarının (PLE) etkisini karşılaştırmak.

Gereç ve Yöntem: Bu retrospektif çalışmaya yenidoğan yoğun bakım ünitesinde (YDYBÜ) Ocak 2011 – Şubat 2012 döneminde yatan,  cerrahi operasyon geçirip 2 haftada ve daha uzun süreli PB ihtiyacı olup PB ilişkili kolestaz gelişen hastalar çalışmaya alındı. Hastalar Grup1, kolestazı olup standart kolestaz tedavisine ek olarak standart PLE (saf soya yağı içeren) verilen, Grup 2  ise ek olarak soya yağı, orta zincirli yağ asidi, zeytin ve balık yağı içeren çok bileşenli PLE verilen olmak üzere iki gruba ayrıldı. Hastaların YYBÜ’de izleminde kolestaz süreleri ve prognozları ile ilgili verileri karşılaştırıldı.

Bulgular: Bu çalışmaya Grup 1 (n= 11) ve Grup 2 (n= 13)’de toplam 24 hasta dâhil edildi. Grup 1 ve 2 için ortalama gestasyonel yaşlar sırasıyla 36±4.3 ve 30.3±3.4 hafta, doğum ağırlıkları ortalama 2395±635 ve 1404 ±670 g idi. Doğum haftaları ve doğum ağırlığı arasında önemli istatistiksel farklılık vardı (sırasıyla p=0.047, p=0.03). Grupların gebelik haftası ve doğum ağırlıkları farklı olmasına rağmen, toplam beslenmeme süresi (Grup 1: 10±3.3 gün; Grup 2: 16.3±10.6 gün) ve total PB süreleri  (Grup 1: 20±4.6 gün; Grup 2: 25.8±17 gün) ve mortalite oranları karşılaştırıldığında gruplar arasında önemli farklılık saptanmadı. Çok bileşenli PLE kullanımına bağlı kısa dönemde yan etki saptanmadı.

Sonuç: Yapılan retrospektif çalışmada değerlendirmeye alınan hastaların demografik verileri arasında fark olmasına rağmen parenteral beslenme ilişkili kolestaz açısından daha riskli olan prematüre bebeklerin sonuçları term bebekler ile benzerdi. Bununla birlikte iki grup  arasında balık yağı içeren çok bileşenli PLE’nin kolestaz ilaç tedavisine ek olarak kullanılmasının, standart PLE kullanılmasına göre ek katkı sağlamadığı gösterildi.  Gruplar arasındaki farkların bu sonucu etkileyebileceğini düşünmekteyiz.

Anahtar Kelimeler

• Parenteral beslenme
• kolestaz
• cerrahi vaka
• çok bileşenli lipid emülsiyonu

Kaynakça

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