Impact of Intravenous Lipid Emulsions on Coagulation Parameters in Hospitalized Pediatric Patients: A Multicenter Retrospective Cohort Study.

OBJECTIVES

Intravenous lipid emulsions (ILEs) are essential components of parenteral nutrition (PN) in pediatric patients, but their effects on coagulation parameters remain incompletely characterized. This study aimed to assess the impact of ILE exposure on coagulation function in hospitalized children.

METHODS

This multicenter retrospective cohort study analyzed electronic medical records from three tertiary Grade A hospitals in China. Patients aged ≤18 years receiving PN with ILEs for ≥5 consecutive days were matched 1:1 via propensity score matching to controls on PN without ILEs or exclusive enteral nutrition. Primary outcomes included changes in coagulation parameters (PT, aPTT, INR, FIB, PLT). Coagulation dysfunction was diagnosed according to the 2024 Chinese Medical Education Association criteria harmonized with ISTH guidelines.

RESULTS

A total of 698 patients (349 per group) were included. The proportion of patients meeting the platelet count criterion (<100×109/L) was significantly higher in the ILEs group than in the control group (2.6% (4/152) vs 0.0% (0/197), P = 0.022). The overall coagulopathy diagnosis rate did not differ significantly between the groups (11.8% (18/152) vs 7.6% (15/197), P = 0.181). No cases of coagulation failure occurred in either group. multivariable logistic regression identified ILEs use (adjusted OR = 1.447 (95% CI: 1.006-2.082), P = 0.046) and baseline PT (adjusted OR = 1.110 (95% CI: 1.031-1.195), P = 0.005) remained independent risk factors for incident coagulopathy, whereas baseline PLT emerged as a protective factor (OR = 0.997 (95% CI: 0.995-0.999), P<0.001). Significant differences were observed in changes of MPV, Eosinophil differential count , RBC, Hb, TBIL, DBIL, ALB between groups.

CONCLUSIONS

Continuous ILE exposure for ≥5 days independently increases the risk of coagulopathy in hospitalized pediatric patients. These findings support the implementation of standardized coagulation monitoring protocols during pediatric PN, particularly for patients with prolonged baseline prothrombin time, and warrant further optimization of lipid emulsion formulations to minimize hematological adverse effects.