{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T14:14:24Z","timestamp":1777126464609,"version":"3.51.4"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Critically ill pediatric patients often require parenteral nutrition (PN) in the intensive care unit (ICU). Literature suggests mixed lipid emulsions (LE) with soybean oil reduction strategies may improve outcomes.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine the association of a hospital-wide switch to a mixed-lipid formula (4-OLE) with pediatric outcomes.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>Retrospective cohort study at a large US academic referral center. Pediatric patients aged 1 month to 17 years requiring parenteral nutrition from May 2016 to September 2019 were included. Data were analyzed from October 2020 to February 2023.<\/jats:p><\/jats:sec>Exposure<\/jats:title>In 2017, Duke University Health System fully converted to a soybean oil\/MCT\/olive\/fish oil lipid (4-OLE) from pure soybean oil\u2013based LE in pediatric patients. Pediatric patients before the change (Intralipid [IL] group) were compared with patients after (4-OLE group).<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Clinical outcomes were compared between treatment periods via multivariable regression models. The primary outcome was hospital length of stay (LOS). Fourteen secondary outcomes included hospital mortality of any cause, 30-day or 90-day readmission, pneumonia, urinary tract infections (UTIs), total caloric delivery, and liver function tests (aspartate aminotransferase, alanine transaminase, alkaline phosphatase, and total bilirubin).<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 684 children dependent on PN were identified (342 were critically ill), with 30% (206 children) in the preswitch (IL) period and 70% (478 children) in the postswitch (4-OLE) period; 123 were male (59.7%). In comparing IL vs 4-OLE, there was a significant difference in median (IQR) age (4.0 [1.2-13.0] vs 3.0 [0.8-9.0] years, respectively; P<\/jats:italic>\u2009=\u2009.04), without difference in body mass index or baseline comorbidities except for significant differences in cancer diagnosis (26 patients in the IL group [12.6%] vs 29 patients in the 4-OLE group [6.1%]; P<\/jats:italic>\u2009=\u2009.004) and chronic obstructive pulmonary disease (24 patients in the IL group [11.7%] vs 30 patients in the 4-OLE group [6.3%]; P<\/jats:italic>\u2009=\u2009.02). In the all children cohort, 4-OLE was associated with shorter hospital LOS (IRR, 0.81; 95% CI, 0.05-0.78), and reduced UTI risk (OR, 0.33; 95% CI, 0.18-0.64). In the ICU cohort, 4-OLE was associated with shorter hospital LOS (IRR, 0.81; 95% CI, 0.78-0.83), and reduced UTI risk (OR, 0.23; 95% CI, 0.11-0.51). Other secondary outcomes were not significant.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this observational study of clinical outcomes among children dependent on PN, a switch to 4-OLE in a large academic hospital was associated with a significant decrease in hospital LOS in ICU and non-ICU patients. These findings suggest switching to a soy\u2013LE sparing strategy using 4-OLE is feasible, safe, and associated with improved clinical outcomes in pediatric PN patients.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.32389","type":"journal-article","created":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T15:21:00Z","timestamp":1693927260000},"page":"e2332389","source":"Crossref","is-referenced-by-count":9,"title":["Change to Mixed-Lipid Emulsion From Soybean Oil\u2013Based Lipid Emulsion in Pediatric Patients"],"prefix":"10.1001","volume":"6","author":[{"given":"Krista L.","family":"Haines","sequence":"first","affiliation":[{"name":"Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina"},{"name":"The Critical Care and Perioperative Epidemiologic Research Unit, Duke University Medical Center, Durham, North 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Medical Center, Durham, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harold","family":"Leraas","sequence":"additional","affiliation":[{"name":"Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles N.","family":"Trujillo","sequence":"additional","affiliation":[{"name":"Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vijay","family":"Krishnamoorthy","sequence":"additional","affiliation":[{"name":"The Critical Care and Perioperative Epidemiologic Research Unit, Duke University Medical Center, Durham, North Carolina"},{"name":"Departement of Anesthesiology, Duke University Medical Center, Durham, North 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