Abstract
Background: Deterioration of liver function, or intestinal failure-associated liver disease, is often observed in long-term parenterally fed children. Fish oil-based intravenous lipids have been reported to play a role in the prevention and treatment of intestinal failure associated liver disease. Methods: This retrospective analysis included 40 pediatric patients, (20 male and 20 female), median age 38 months (range 1.5–200 months) on long-term (≥1 month) parenteral nutrition who received the parenteral mixtures containing a combination of a third-generation lipid emulsion and pure fish oil because of laboratory liver function abnormalities. The total dose of fish oil from both emulsions for each patient exceeded 0.5 g/kg/day. Data from visits in an outpatient clinic were retrospectively analyzed using the Wilcoxon test, Mann-Whitney test, and Spearman correlation test. Results: The median time of therapy was 149 days (range 28–418 days). There was a decrease of median total and direct (conjugated) bilirubin concentration from 22.23 µmol/L (range 3.42–243 µmol/L) to 10.26 µmol/L (range 3.42–180.58 µmol/L; p < 0.005) and 8.55 (range 1.71–212.04 µmol/L) to 6.84 µmol/L (range 1.71–150.48 µmol/L; p < 0.007) respectively. A significant decrease in median alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl transferase was also observed. In 11 patients bilirubin concentrations increased or remained unchanged. When compared to the patients who responded to the combination therapy, the patients who did not respond received parenteral nutrition for a longer time prior to the start of the therapy (51 vs. 30 months; p < 0.05). Conclusions: The mixture of an intravenous lipid emulsion containing soybean oil, medium-chain triglycerides, olive oil, and fish oil with the addition of pure fish oil emulsion may be helpful in the treatment of liver complications in children on long-term parenteral nutrition.
Highlights
Long-term parenteral nutrition is a lifesaving treatment for patients with intestinal failure.In the pediatric population, short bowel syndrome (SBS), gastroschisis, pseudoobstruction syndrome, inflammatory bowel disease and congenital enteropathies, are the most frequent indications for long-term parenteral nutrition [1]
From 2013 to 2016, we identified 40 pediatric patients, 20 male and 20 female, with a median age of 38 months on long-term (≥ 1 month) parenteral nutrition who received a combination of third-generation lipid emulsion and pure fish oil because of abnormally high bilirubin concentrations and/or liver enzymes according to norms in our laboratory (Table 2)
In 2005, a case report concerning the reduction of intestinal failure-associated liver disease (IFALD) upon introduction of fish oil-based lipid emulsion was published
Summary
Long-term parenteral nutrition is a lifesaving treatment for patients with intestinal failure. Short bowel syndrome (SBS), gastroschisis, pseudoobstruction syndrome, inflammatory bowel disease and congenital enteropathies, are the most frequent indications for long-term parenteral nutrition [1]. One of the most frequent non-infectious complications of long-term parenteral nutrition in children is intestinal failure-associated liver disease (IFALD) [2,3]. IFALD is a severe condition which can lead to liver cirrhosis and liver failure. Deterioration of liver function, or intestinal failure-associated liver disease, is often observed in long-term parenterally fed children. Fish oil-based intravenous lipids have been reported to play a role in the prevention and treatment of intestinal failure associated liver disease
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