Elimination of soybean lipid emulsion in parenteral nutrition and supplementation with enteral fish oil improve cholestasis in infants with short bowel syndrome.
BACKGROUND
Parenteral nutrition-associated liver disease (PNALD) is a potentially fatal complication for children with intestinal failure. Fish oil-based lipid emulsions have shown promise for the treatment of PNALD but are not readily available. Six cases are presented in which cholestasis resolved after soybean lipid emulsion (SLE) was removed from parenteral nutrition (PN) and enteral fish oil was given.


METHODS
A retrospective review at a tertiary children's hospital (July 2003 to August 2008) identified 6 infants with intestinal failure requiring PN for >6 months who developed severe hepatic dysfunction that was managed by eliminating SLE and providing enteral fish oil.


RESULTS
Twenty-three infants with short bowel syndrome requiring prolonged PN developed cholestasis. SLE was removed in 6 of these patients, and 4 of the 6 received enteral fish oil. Standard PN included 2-3 g/kg/d SLE with total PN calories ranging from 57 to 81 kcal/kg/d at the time of SLE removal. Hyperbilirubinemia resolved after elimination of SLE within 1.8-5.4 months. Total PN calories required to maintain growth generally did not change.


CONCLUSIONS
Temporary elimination of SLE and supplementation with enteral fish oil improved cholestasis in PN-dependent infants. Further trials are needed to evaluate this management strategy.
Rollins
Michael D
MD
Children's Medical Center, University of Utah, Salt Lake City, Utah 84113-1103, USA. michael.rollins@hsc.utah.edu
Scaife
Eric R
ER
Jackson
W Daniel
WD
Meyers
Rebecka L
RL
Mulroy
Cecilia W
CW
Book
Linda S
LS
D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D004750:Enteral Nutrition; D005217:Fat Emulsions, Intravenous / Q000009:adverse effects / Q000737:chemistry* / Q000627:therapeutic use; D005395:Fish Oils / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000150:complications / Q000628:therapy*; D013024:Soybean Oil / Q000009:adverse effects; D013025:Glycine max; D015996:Survival Rate; D016896:Treatment Outcome
D005217:Fat Emulsions, Intravenous; D005395:Fish Oils; D013024:Soybean Oil