Is the use of parenteral omega-3 lipid emulsions justified in surgical neonates with mild parenteral nutrition-associated liver dysfunction?
OBJECTIVE
Although evidence suggests that parenteral omega-3 lipid emulsions (O-3LEs) may be beneficial in treating advanced parenteral nutrition (PN)-associated liver disease, our objective was to determine if O-3LEs are justified in those with early liver disease.


METHODS
This is a retrospective analysis of prospectively collected data on all surgical neonates, who received more than 1 day of PN postoperatively between 2001 and 2004 with observation through 2005 (era before O-3LE introduction). We examined the proportion of those who developed mild and advanced liver dysfunction.


RESULTS
Of the 292 infants in the cohort, 104 (36%) developed mild liver dysfunction (conjugated bilirubin, 34 micromol/L [cBili34]) after a mean of 22 days. Thirty-one (30%) of the cBili34 patients reached a serum conjugated bilirubin of 100 micromol/L, and 13 (13%) developed liver failure. Of these, 4 underwent transplantation, and 5 died of hepatic disease. Overall, 86 of the cBili34 patients (83%) were weaned off PN.


CONCLUSIONS
With more than 80% of cBili34 patients being weaned from PN without adverse hepatic sequelae, it is difficult, in the absence of definitive evidence of efficacy and safety for O-3LEs together with increased costs, to justify the routine use of O-3LEs in this low-risk population outside formal research protocols.
Nasr
Ahmed
A
Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada.
Diamond
Ivan R
IR
de Silva
Nicole T
NT
Wales
Paul W
PW
D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008107:Liver Diseases / Q000209:etiology / Q000628:therapy*; D017093:Liver Failure / Q000209:etiology / Q000517:prevention & control; D008297:Male; D015999:Multivariate Analysis; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods*; D011182:Postoperative Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000150:complications
D005217:Fat Emulsions, Intravenous; D015525:Fatty Acids, Omega-3