Optimization of Intravenous Lipid Emulsion Use in Pediatric Patients Receiving Parenteral Nutrition at Harborview Medical Center

Current Harborview Medical Center (HMC) practice is to initiate pediatric parenteral nutrition (PN) with a soy-based intravenous lipid emulsion (SOILE) and monitor aspartate aminotransferase (AST) and alanine aminotransferase (ALT) weekly to assess liver function. If these labs are measured three times above normal twice, the patient is transitioned to soy-, MCT-, olive-, fish-oil lipid emulsion (SMOF-ILE), a mixed-lipid emulsion.

In 2018, ESPGHAN/ESPEN/ESPR released pediatric PN guidelines strongly recommending patients be started on SMOF-ILE if expected to receive PN for more than a few days. This is based on an increased risk of developing intestinal failure-associated liver disease (IFALD) while on PN. IFALD is characterized by cholestasis, defined by a conjugated bilirubin of ≥2 mg/dL.

This quality improvement project evaluated whether pediatric PN practices at HMC align with current evidence and guidelines and identified opportunities to reduce the risk of liver dysfunction through earlier SMOF-ILE use and improved monitoring.

Materials Available

• Poster

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Project Type(s): MNT Concentration Clinical Poster

Author(s): Skyler Austin

Program(s): Master of Science, RDN Training

Year: 2026

Adviser(s):

• Michelle Averill