title: Implementation of a multidisciplinary team approach and fish oil emulsion administration in the management of infants with short bowel syndrome and parenteral nutrition-associated liver disease.
abstract: OBJECTIVE
  To describe the authors' experience with the implementation of a multidisciplinary approach and use of fish oil emulsion (FOE) in the management of infants with short bowel syndrome (SBS) and parenteral nutrition-associated liver disease (PNALD).
  
  
  METHODS
  Between August 2006 and June 2009, four cases of SBS and severe PNALD were managed by the team using specifically developed protocols. The FOE was initiated if serum direct bilirubin levels were ≥100 µmol/L. To quantify the degree of exposure to high serum direct bilirubin levels over time, the area under the curve (AUC) for each patient was calculated before and after initiation of FOE. Linear regression analyses were performed to evaluate correlations between the AUC, duration of cholestasis and initiation of FOE.
  
  
  RESULTS
  All patients survived and no complications were observed during the study period. After the first patient, FOE was initiated progressively earlier, but poor correlation between the AUC before and after its introduction was observed (r(2)=0.41924). However, there was strong correlation between the duration of PNALD before FOE initiation and time to resolution (r(2)=0.72133): the earlier the FOE was initiated, the shorter the time to resolution.
  
  
  CONCLUSIONS
  The authors report a positive experience with the implementation of a multidisciplinary approach and the use of FOE in infants with SBS and severe PNALD. The earlier the FOE was initiated during the cholestatic process, the shorter the time to resolution. The present study is a hypothesis generator, raising the question of whether an earlier introduction of this particular therapy can effectively shorten the cholestasis process in these patients.
authors.affiliation: Division of Pediatric Gastroenterology, Montreal Children's Hospital, McGill University, Montreal, Quebec H3H 1P3, Canada. ana.santanna@mcgill.ca
authors.forename: Ana M G A
authors.initials: AM
authors.lastname: Sant'Anna
authors.forename: Eyad
authors.initials: E
authors.lastname: Altamimi
authors.forename: Rose-Frances
authors.initials: RF
authors.lastname: Clause
authors.forename: Joanne
authors.initials: J
authors.lastname: Saab
authors.forename: Heather
authors.initials: H
authors.lastname: Mileski
authors.forename: Brian
authors.initials: B
authors.lastname: Cameron
authors.forename: Peter
authors.initials: P
authors.lastname: Fitzgerald
authors.forename: Guilherme M
authors.initials: GM
authors.lastname: Sant'Anna
mesh_terms: D005395:Fish Oils / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008099:Liver / Q000503:physiopathology; D008107:Liver Diseases / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D010288:Parenteral Nutrition / Q000009:adverse effects*; D010348:Patient Care Team; D012778:Short Bowel Syndrome / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D014280:Triglycerides
chemical_list: D005395:Fish Oils; D014280:Triglycerides; C568345:fish oil triglycerides