Reduced risk of pulmonary embolism in children treated with long term parenteral nutrition

Researchers at Great Ormond Street Hospital (GOSH) have shown a reduction in the incidence of pulmonary embolism in patients receiving parenteral nutrition after the introduction of a new mixed intravenous lipid emulsion.

Thirty-five per cent of patients receiving parenteral nutrition will have pulmonary embolism. However, since the introduction of a new intravenous lipid emulsion in 2003 there has been a reduction. The intravenous lipid emulsion given prior to 2003 contained Ω-6 fatty acids and has been shown to generate a pro-inflammatory response and impair immune system function. New intravenous lipid emulsion’s have the beneficial effect of reducing Ω-6 fatty acids, with a shift towards a less inflammatory state.

The aim of the study was to compare the incidence and severity of pulmonary embolism before and after the change in parenteral nutrition lipids in 2003, through retrospectively reviewing surveillance ventilation-perfusion (V/Q) scintigraphies.

The findings showed that with the change in intravenous lipid emulsion after 2003 the number of patients who had a pulmonary embolism at some point during parenteral nutrition significantly dropped from 45 per cent to 11 per cent.

However, patients receiving the new mixed intravenous lipid emulsion’s were still at risk of pulmonary embolism, therefore regular surveillance on an annual basis with V/Q scintigraphy was recommended.

The project is being led by BRC supported Dr Lorenzo Biassoni. Findings have been published in Clinical Nutrition, March 2016.