632 - Enteral Lipid Supplements for Prevention and Treatment of Parenteral Nutrition-Associated Liver Disease in Infants: A Systematic Review and Meta-analysis

Publication Number: 632.4632

Muralidhar Premkumar, Baylor College of Medicine, Houston, TX, United States; Katie Huff, Indiana University School of Medicine, Indianapolis, IN, United States; Chris Cooper, University of Bristol, Bristol, England, United Kingdom; Jane Cracknell, Cochrane Neonatal, Faringdon, England, United Kingdom; Mohan Pammi, Baylor College of Medicine, Houston, TX, United States

Background: Preclinical studies suggest that enteral lipid supplements may offer benefits, but their effectiveness and safety in preventing and treating parenteral nutrition-associated liver disease (PNALD) in infants remain unknown.

Objective: To determine the effectiveness and safety of enteral lipid supplementation for preventing and treating PNALD in infants.

Design/Methods: We included parallel and cross-over randomized control trials (RCT) comparing enteral lipid supplements versus controls in at-risk infants or those with PNALD. We searched CENTRAL, MEDLINE, Embase, and trials registers in July 2024. Our primary outcomes included prevention and resolution of PNALD. This abstract is based on a draft and pre-peer review version of a Cochrane Review. Upon completion and approval, the final version is expected to be published in the Cochrane Database of Systematic Reviews (www.cochranelibrary.com).

Results: Fourteen studies (n= 2,246 subjects) were included. The type, duration, and dose of enteral lipids varied across studies. We performed a combined analysis of any enteral-lipid vs. controls (14 studies) and subgroup analysis of either any algal oil (8 studies) or fish oil (6 studies) lipids vs controls. None of the studies focused on the prevention or treatment of PNALD as the primary outcome. Multiple studies reported on PNALD, mortality, infection, and feeding intolerance (Table). The enteral lipid supplementation group had similar rates of PNALD compared to the control group (Odds ratio (OR) 0.66, 95% confidence interval (CI) 0.26, 1.71; 3 studies; n = 265; very low-certainty evidence). The analysis did not reveal any differences in mortality between the enteral lipid group and the control group (OR 1.19, 95% CI 0.86, 1.66; 11 studies; n = 2,200; low-certainty evidence). No evidence of difference in infection rates was found between the enteral lipid group and the control group (typical OR 0.86, 95% CI 0.68, 1.10; 5 studies; n = 1,478; low-certainty evidence). There were no differences in the incidence of feeding intolerance between the enteral lipid group and the control group (OR 0.13, 95% CI 0.02, 1.07; 3 studies; n = 200; very low-certainty evidence). Scarcity of studies prevented analyses for time to full feeds, length of stay, and growth.

Conclusion(s): There is currently insufficient evidence from RCTs to suggest with any certainty that enteral lipids are associated with beneficial or harmful outcomes in infants at risk or with PNALD. We recommend well-designed, randomized trials to address effectiveness and safety of enteral lipids and clarify lipid type, dose, and duration for optimal clinical outcomes.

Table. Summary of Findings
Summary of findings

Table. Summary of Findings
Summary of findings