Prevention and reversal of intestinal failure–associated liver disease in premature infants with short bowel syndrome using intravenous fish oil in combination with omega-6/9 lipid emulsions

• Published in: Journal of pediatric surgery 2011-07, Vol.46 (7), p.1361-1367
• Main Authors: Lilja, Helene Engstrand, Finkel, Yigael, Paulsson, Mattias, Lucas, Steven
• Format: Article
• Language: English
• Subjects: Catheter-Related Infections - complications; Colon - pathology; Dermatologi och venerologi, klinisk genetik, invärtesmedicin; Dermatology and venerology,clinical genetics, internal medicine; Drug Administration Schedule; Drug Therapy, Combination; Emulsions - administration & dosage; Emulsions - therapeutic use; Enterocolitis, Necrotizing - complications; Enterocolitis, Necrotizing - surgery; Fat Emulsions, Intravenous - administration & dosage; Fat Emulsions, Intravenous - therapeutic use; Female; Fish oil-based lipid emulsion; Fish Oils - administration & dosage; Fish Oils - therapeutic use; Gastroschisis - complications; Gastroschisis - surgery; Humans; Ileocecal Valve - pathology; Ileocecal Valve - surgery; Ileostomy - adverse effects; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - drug therapy; Infant, Premature, Diseases - prevention & control; Infusions, Intravenous; Internal medicine; Intestinal Atresia - complications; Intestinal Atresia - surgery; Intestinal failure–associated liver disease (IFALD); Invärtesmedicin; Jejunostomy - adverse effects; Liver Failure - drug therapy; Liver Failure - prevention & control; Male; MEDICIN; Medicin och hälsovetenskap; MEDICINE; Omega-6/9 lipid emulsion; Paediatric medicine; Pediatrics; Pediatrisk medicin; Phospholipids - administration & dosage; Phospholipids - therapeutic use; Plant Oils - administration & dosage; Plant Oils - therapeutic use; Short bowel syndrome; Short Bowel Syndrome - complications; Short Bowel Syndrome - drug therapy; Short Bowel Syndrome - surgery; Soybean Oil - administration & dosage; Soybean Oil - therapeutic use; Surgery
• ISSN: 0022-3468; 1531-5037; 1531-5037
• DOI: 10.1016/j.jpedsurg.2010.12.021

Abstract Although premature infants with short bowel syndrome are at the highest risk of developing intestinal failure–associated liver disease (IFALD), they have great capacity for intestinal growth and adaptation if IFALD can be prevented. Conventional soybean oil–based intravenous lipid emulsions have been associated with IFALD. This study presents data on 5 premature neonates with short bowel syndrome treated with a combination of parenteral fish oil– and olive/soybean-based lipid emulsion for periods ranging between 7 and 17 months. Despite an enteral tolerance of less than 50% in 4 of these patients during their first year of life, direct bilirubin levels normalized while on this combination of ClinOleic (Baxter, Maurepas, France)/Omegaven (Fresenius Kabi, Bad Homburg, Germany) at a 1:1 ratio. None of our patients developed irreversible IFALD even though all of them were premature, had undergone multiple major surgical procedures, and had experienced several episodes of sepsis. Thus far, we have not seen any adverse effects of this mixed lipid emulsion in these preterm infants. All 5 patients are growing and developing well and have normal liver function.