The use of alternative lipid emulsions in paediatric and neonatal parenteral nutrition

Lipid emulsions are an important part of paediatric parenteral nutrition as they provide energy, fat soluble vitamins and are a source of essential fatty acids. Soya bean based oil emulsions have however been identified as one of the major causative factors in the development of PN related cholestasis. The newer lipid emulsion containing fish oil has been shown to reduce the risk of such complications. Nevertheless, some centers advise that parenteral lipid intake should be discontinued when parenteral nutrition associated cholestasis (PNAC) develops. This practice is, however, not recommended as it can be detrimental to infants who have limited fat stores. Such practices, could also potentially lead to growth failure and essential fatty acid deficiency. Increasing daily intravenous glucose intake as a compensatory measure for the omission of lipid emulsions is not recommended as it may induce insulin resistance and the risk of liver steatosis due to lipogenesis.1,2