Multicomponent Parenteral Lipid Emulsions Do Not Protect Against Liver Injury in Neonatal Pigs with Obstructive Cholestasis

Biliary atresia (BA) is a pediatric liver disease that often necessitates parenteral nutrition (PN) to support growth due to impaired liver function. While soy oil lipid emulsions (SLE) are commonly used in PN, they may contribute to cholestatic liver injury. In contrast, mixed oil lipid emulsions (MLE) have shown promise in preventing cholestasis in non-BA infants, potentially by restoring bile flow. However, their effectiveness in cases of complete bile duct obstruction, as seen in BA, remains uncertain. To explore the potential benefits of MLE in BA, we utilized a neonatal pig model of bile duct ligation (BDL). Pigs underwent either BDL or sham surgery and were subsequently fed either MLE or SLE via PN, or enterally with formula. The MLE-BDL pigs exhibited significantly greater weight gain compared to those fed SLE or formula enterally. Additionally, MLE-BDL pigs showed higher serum bile acid and gamma-glutamyl transferase concentrations compared to SLE-BDL pigs. However, no significant differences in liver injury, assessed by ductular reaction or fibrosis, were observed between MLE- and SLE-BDL pigs. Based on weight gain alone, MLE may be a superior lipid emulsion for use in neonates with obstructive cholestasis. Overall design: Piglets at day 1 of life following c-section delivery were randomly assigned to receive either sham (sham) or bile duct ligtation surgery (BDL) and implanted with jugular catheters and orogastric tubes. After surgery, piglets were assigned to one of three diet groups: enteral feeds (ENT), or parenteral nutrition containing soy-based lipid (IL) or mixed lipid (SL). Piglets were maintained on these diets for 14 days then euthanized and liver samples were collected.