Abstract
BackgroundParenteral nutrition-associated cholestasis (PNAC) is a serious complication in preterm infants receiving prolonged parenteral nutrition. Soybean lipid emulsion (SLE) seems to have a role in its pathogenesis, whereas fish oil-based emulsion (FOLE) seems to be able to reverse cholestasis. This study aimed to evaluate the effectiveness of a FOLE in reversing PNAC.MethodsThe effectiveness in reversing PNAC was evaluated in prospective cohort study of very preterm infants when compared to historical controls: twenty-six infants (27.0 ± 2.6 weeks GA; 724 ± 204 g) who developed cholestasis while receiving SLE were shifted to receive FOLE and were compared with 30 infants (27.3 ± 2.5 weeks GA¸ 838 ± 277 g) who continued to receive SLE at diagnosis of cholestasis.ResultsTime to reversal of cholestasis was the same in the two study groups (45 ± 21 vs 43 ± 32 days).ConclusionsFOLE does not seem to be superior to SLE in reversing cholestasis. Considering that definitive data on the actual efficacy of FOLE to reverse PNAC are lacking, larger randomized trials are required, mainly to asses if FOLE may have a role in PNAC prevention rather than PNAC treatment.
Highlights
Parenteral nutrition-associated cholestasis (PNAC) is a serious complication in preterm infants receiving prolonged parenteral nutrition
Its long-term use is associated with serious complications, such as PN-associated cholestasis (PNAC)
All infants with PNAC were switched from Soybean lipid emulsion (SLE) to fish oil-based emulsion (FOLE) at the time of diagnosis
Summary
Parenteral nutrition-associated cholestasis (PNAC) is a serious complication in preterm infants receiving prolonged parenteral nutrition. Its long-term use is associated with serious complications, such as PN-associated cholestasis (PNAC). Risk factors for PNAC include low birth weight, prematurity, prolonged PN use, lack of enteral intake, enzyme deficiencies, genetic causes, anatomic factors, susceptibility to cholestatic injury, and factors relevant to the PN itself. The most effective treatment for PNAC is increasing enteral energy intake while weaning off PN but, in about 3–15% of patients, end-stage liver disease develops and liver/small bowel transplantation remains the only treatment option. Mortality rate in cholestatic infants with end stage liver disease almost reaches 100% within one year from the diagnosis, unless PN can be discontinued or liver/small bowel transplantation can be performed [3]
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