Impact of soybean oil lipid emulsion on clinical outcomes in critically ill pediatric patients.

BACKGROUND & AIMS: Lipid emulsions are key components of parenteral nutrition (PN); however, concerns persist that soybean oil-based lipid emulsions may increase the risk of infection and catheter occlusion. In pediatric intensive care settings, evidence on the safety of these emulsions remains limited. This study investigated the impact of soybean oil-based lipid emulsion on central venous catheter-related complications and clinical outcomes in children receiving PN in a pediatric intensive care unit (PICU).

METHODS: We conducted a single-center retrospective study of children admitted to the PICU between 2018 and 2023 who underwent PN for >7 days. Patients who received PN before PICU admission were excluded. Of the 4589 PICU admissions, 172 patients were included and divided into two groups based on soybean oil-based lipid emulsion administration: 67 patients received the lipid emulsion, and 105 did not. The primary outcomes were catheter occlusion and central line-associated bloodstream infection (CLABSI). Secondary outcomes included duration of mechanical ventilation, length of stay in the PICU, and mortality. Catheter-level analysis was also performed to evaluate the complication rates and catheter survival based on lipid emulsion exposure.

RESULTS: At the patient level, catheter occlusion occurred in 4.5 % of the lipid emulsion-treated group and 2.9 % of the non-treated group (p = 0.68), whereas CLABSI occurred in 7.5 % of the lipid emulsion-treated group and 3.8 % of the non-treated group (p = 0.31), with no significant differences. In the catheter-level analysis, the incidence of CLABSI per 1000 catheter-days was 2.69 in the treated group and 1.40 in the non-treated group (p = 0.30). No significant differences were observed in catheter survival or complication rates.

CONCLUSION: Soybean oil-based lipid emulsions administered via a central venous catheter did not increase the risk of catheter occlusion nor of CLABSI in critically ill pediatric patients. These findings support the safe use of soybean oil-based intravenous lipid emulsions in PICUs when enteral nutrition is not feasible.