The Role of Parenteral Lipids in the Development of Advanced Intestinal Failure-Associated Liver Disease in Infants: A Multiple-Variable Analysis

Background: Given the recent interest in the role of omega-6 lipids in the development of intestinal failure-associated liver disease (IFALD), the authors sought to examine the role of parenteral lipids in the development of a serum conjugated bilirubin > 100 mu mol/L (5.9 mg/dL; CB100) in infants. Method: Between 2003 and 2004, data were collected prospectively on infants undergoing an abdominal surgical procedure. Univariate logistic regression models for the prediction of CB100 by 1 year postoperatively were developed. Predictors significant at the 0.2 level on univariate analysis were entered into a backward stepwise multiple variable logistic regression. Results: Of 152 infants who received parenteral nutrition (PN) postoperatively, 22 developed CB100. Predictors that met criteria for consideration in the multiple-variable model were age, weight, small bowel length, presence of a stoma, proportion of enteral feeds postoperatively, septic episodes, days of maximal PN amino acid (> 2.5 g/kg/d), days of maximal lipid (> 2.5 g/kg/d), and PN duration. The final model included septic episodes (odds ratio, 3.23; 95% confidence interval, 1.8-5.9) and days of lipid > 2.5 g/kg/d (1.04; 1.003-1.06). At 60 days of maximal lipid, the odds of advanced IFALD were increased 10-fold. Conclusions: This model suggests a key role of parenteral lipids and septic events in the development of CB100 from IFALD. These data may provide targets, such as careful line care, reduction in maximal lipid dose, or alternate lipids such as omega-3 fatty acids, to prevent CB100, an identified marker of subsequent liver failure from IFALD. (JPEN J Parenter Enteral Nutr. 2011; 35: 596-602)