title: 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.
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.
authors.affiliation: Department of Pediatric Surgery, University Children's Hospital, SE-751 85 Uppsala, Sweden. helene.lilja@kbh.uu.se
authors.forename: Helene Engstrand
authors.initials: HE
authors.lastname: Lilja
authors.forename: Yigael
authors.initials: Y
authors.lastname: Finkel
authors.forename: Mattias
authors.initials: M
authors.lastname: Paulsson
authors.forename: Steven
authors.initials: S
authors.lastname: Lucas
mesh_terms: D055499:Catheter-Related Infections / Q000150:complications; D003106:Colon / Q000473:pathology; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004655:Emulsions / Q000008:administration & dosage / Q000627:therapeutic use; D020345:Enterocolitis, Necrotizing / Q000150:complications / Q000601:surgery; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage / Q000627:therapeutic use*; D020139:Gastroschisis / Q000150:complications / Q000601:surgery; D006801:Humans; D007080:Ileocecal Valve / Q000473:pathology / Q000601:surgery; D007081:Ileostomy / Q000009:adverse effects; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy* / Q000517:prevention & control; D007262:Infusions, Intravenous; D007409:Intestinal Atresia / Q000150:complications / Q000601:surgery; D007582:Jejunostomy / Q000009:adverse effects; D017093:Liver Failure / Q000188:drug therapy / Q000517:prevention & control*; D008297:Male; D010743:Phospholipids / Q000008:administration & dosage / Q000627:therapeutic use; D010938:Plant Oils / Q000008:administration & dosage / Q000627:therapeutic use*; D012778:Short Bowel Syndrome / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D013024:Soybean Oil / Q000008:administration & dosage / Q000627:therapeutic use*; D014280:Triglycerides
chemical_list: C568346:ClinOleic; D004655:Emulsions; D005217:Fat Emulsions, Intravenous; D005395:Fish Oils; D010743:Phospholipids; D010938:Plant Oils; D014280:Triglycerides; C568345:fish oil triglycerides; C545823:soybean oil, phospholipid emulsion; D013024:Soybean Oil