Abstract
Intestinal failure-associated liver disease (IFALD) is a life-threatening complication of parenteral nutrition (PN) and is most prevalent in the preterm neonatal population receiving long-term PN. In this study, we report the outcome of our experience with fish oil monotherapy for IFALD in a fish oil-based combination lipid emulsion administered to preterm low birth weight infants. Fasting neonates were administered as PN according to our center’s nutrition protocol. A diagnosis of IFALD was made when the serum direct bilirubin levels were >2.0 mg/dL in two consecutive measurements that were more than one week apart, without evidence of intrinsic causes of liver dysfunction. The management of IFALD was conducted by switching the lipid emulsion from combination lipid emulsion to fish oil monotherapy at 1.0 g/kg/day, infused over 24 h. Fifteen infants met the criteria for IFALD and received fish oil monotherapy. The median gestational age was 27.5 weeks and the median birth weight was 862.5 g. IFALD was successfully reversed in 11 infants (11/15, 73.3%). The median duration of fish oil monotherapy was 39 days. Direct bilirubin values were initially elevated and then steadily declined from the third week of treatment onward. The enteral tolerance increased in varying degrees during the treatment period. The mean weight gain was 26.0 g/day during fish oil monotherapy. Omegaven® (Fresenius Kabi Austria Gmbh, Graz, Austria) at a dose of 1.0 g/kg/day was well tolerated, and no adverse events related to Omegaven use were seen. The reversal of IFALD in preterm infants on combination lipid emulsion containing fish oil was achieved by switching to fish oil monotherapy.
Highlights
The theoretical background for using combination lipid emulsions (LE) containing fish oil is based upon utilizing the advantages of each oil source while reducing the disadvantages of relying on a sole source of oil [1]
A historical cohort of infants managed in our neonatal intensive care unit (NICU) in the era before the application of fish oil (FO) monotherapy for Intestinal failure-associated liver disease (IFALD) was selected by a retrospective review of medical records
Preterm infants in the NICU are at high risk of feeding intolerance and often require parenteral nutrition (PN) support for prolonged periods of time
Summary
The theoretical background for using combination lipid emulsions (LE) containing fish oil is based upon utilizing the advantages of each oil source (i.e., essential fatty acids in soybean oil, anti-inflammatory properties of fish oil) while reducing the disadvantages of relying on a sole source of oil (i.e., phytosterols in soybean oil) [1]. SMOF was approved by the US Food and Drug Administration in 2016 for use in adults. It has been approved and available for use in both children and adult patients in Korea and many centers, including ours, have been using SMOF as the LE of choice since 2008. The clinical advantage of using combination LEs such as SMOF is most relevant in the preservation of liver function during long-term parenteral nutrition (PN) and has been shown to be beneficial in this aspect by previous reports [2,3]. Intestinal failure-associated liver disease (IFALD) is a life-threatening complication of PN and is most prevalent in the preterm neonatal population receiving long-term PN. The pathogenesis of IFALD is multifactorial, while the amount and content of the LE used is closely related to IFALD development and progression
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