Key messages
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As there is no good-quality evidence, we do not know if enteral lipids cause benefits or harms in infants at risk of liver disease or who have liver disease due to prolonged need for artificial nutrition secondary to intestinal failure.
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There were no studies that specifically studied the effect of enteral lipids in infants at risk of liver disease or who have liver disease due to prolonged need for artificial nutrition secondary to intestinal failure.
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To answer this question, we need large studies specifically designed to study the effect of enteral lipids in infants with intestinal failure.
What is parenteral nutrition-associated liver disease?
Infants (children younger than one year) with intestinal failure, who cannot be fed by mouth or a feeding tube, rely on parenteral nutrition (artificial nutrition given through a vein). A common complication of this treatment is parenteral nutrition-associated liver disease (PNALD), which can lead to severe illness or even death if not properly managed. The exact causes of this liver disease are unclear, but contributing factors include artificial nutrition, lack of oral feeding, infections, and surgeries. Currently, there are no fully effective ways to prevent liver disease in infants with intestinal failure. Some types of artificial nutrition, such as those containing fish oil, may help, but they do not completely prevent or treat liver disease in infants with intestinal failure. Therefore, better prevention and treatment strategies are needed.
What are enteral lipids?
Lipids (fats and oils) are essential nutrients that provide energy, transport vitamins, and serve as building blocks for cells. They are also critical for brain and eye development. When lipids are given by mouth or through a feeding tube, they are called enteral lipids. These lipids can come from various sources, including fish, plants, algae, fungi, or synthetic production, and their composition varies depending on the source. Laboratory studies in animals suggest that enteral lipids may help prevent or reduce liver disease in the setting of intestinal failure.
What did we want to find out?
We wanted to know if enteral lipids provide benefits or cause harm in infants at risk of liver disease or who have liver disease due to prolonged need for artificial nutrition secondary to intestinal failure. Specifically, we asked whether enteral lipids could prevent or treat liver disease in infants with intestinal failure.
What did we do?
We searched the medical literature for studies evaluating the benefits and risks of enteral lipids in infants at risk for or already diagnosed with PNALD. We included only studies where enteral lipids were given by mouth or through a feeding tube, and where infants were assigned by chance to different treatment groups. We then compared, analyzed, and summarized the results of these studies, assessing our confidence in the evidence, based on factors such as study methods and the number of infants involved.
What did we find?
We found 11 studies involving 2192 infants at risk of PNALD who received enteral lipids for up to approximately eight weeks. Of these studies, four compared algal oil alone or in combination with other oils to a control group, while three studies compared fish oil alone or in combination with other oils to a control group. The smallest study included 18 infants, while the largest included 1273. Studies were conducted across Asia, Australia, Europe, and the Americas. Several studies were supported by pharmaceutical companies.
Only a few studies assessed the prevention of PNALD. We did not find any studies evaluating enteral lipids (enterally) for the treatment of established liver disease. Eleven studies investigated enteral lipids in infants at risk of liver disease. We found that, compared to no treatment or placebo (no active substance), enteral lipids may have little to no effect on the prevention of: PNALD; feeding intolerance; time to achieve full enteral feeds by mouth or a feeding tube; or mortality. The length of hospital stay may be decreased with enteral lipids, but there is limited information available from only a single study.
Overall, we are uncertain about these results.
No data evaluated the effect of enteral lipids on the need for liver transplantation.
What are the limitations of the evidence?
We are not confident that enteral lipids have any effect on PNALD, feeding intolerance, the time to achieve full enteral feeds, length of hospital stay, or mortality because:
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The studies varied in the type, dose, duration, and administration of enteral lipid;
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Some study participants or researchers may have been aware of which treatment they were receiving;
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Not all studies provided data on all outcomes of interest;
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There were too few studies to draw definitive conclusions, and some were very small.
How up-to-date is this evidence?
The evidence is up-to-date to 16 December 2024.
阅读完整摘要
研究目的
To evaluate the benefits and harms of enteral lipid supplementation for the prevention and treatment of PNALD in infants.
检索策略
We searched CENTRAL, MEDLINE, Embase and trial registers, together with reference checking and contact with study authors. The latest search was in December 2024.
作者结论
The evidence is very uncertain about the effect of enteral lipids on the prevention of PNALD during the hospital stay and in the first year of life. There may be little to no difference in feeding intolerance or time to achieve full enteral feeds. They may decrease the length of stay and likely do not reduce or increase mortality up to discharge or during the first year of life in infants at risk for PNALD.
Due to small samples, inconsistency, and risk of bias, the available data are of very low certainty, and so we are not able to draw conclusions about the effects of enteral lipids in infants who are at risk of PNALD. No studies evaluated resolution of PNALD during the hospital stay and in the first year of life, or the need for liver transplantation.
Well-designed studies are needed to evaluate the short-term and long-term effects of different enteral lipids in infants who are at risk for PNALD or have PNALD. Future studies should focus on addressing the heterogeneity of enteral lipid preparations and the inconsistency in assessment of outcomes.
资助
This Cochrane Review had no dedicated funding.
注册
Protocol (2021) DOI: 10.1002/14651858.CD014353.
