Parenteral ω-3 fatty acid lipid emulsions for children with intestinal failure and other conditions: a systematic review.
BACKGROUND
There is growing interest in the use of ω-3 fatty acid (n-3FA) lipid emulsions to prevent complications associated with parenteral nutrition. The authors systematically reviewed the evidence on the benefits and safety of n-3FA compared with standard lipid emulsions in children with intestinal disease, critical illness, trauma, or postoperative complications.


METHODS
The authors searched 4 bibliographic databases from their inception to March 2011, conference proceedings, trial registries, and reference lists. Two reviewers independently selected studies, assessed methodological quality, and rated the strength of the evidence. One reviewer extracted and a second reviewer verified data. The authors summarized findings qualitatively and conducted meta-analysis when appropriate.


RESULTS
Five randomized controlled trials with unclear risk of bias and 3 high-quality prospective cohort studies were included. The studies examined premature, low birth weight infants (n = 6) and children with heart disease (n = 1) or intestinal failure (n = 1). The strength of evidence was consistently low or very low across all lipid emulsion comparisons and outcomes. In young children, n-3FA emulsions resulted in improvement in some biochemical outcomes of intestinal failure-associated liver disease but no difference in mortality. Few studies examined patient-important outcomes, such as length of hospital and intensive care stay; need for transplantation, growth, and cognitive development; or the long-term effects and potential harms associated with these therapies.


CONCLUSIONS
Currently, there is a lack of sufficient high-quality data to support the use of parenteral n-3FA lipid emulsions in children. Future trials examining long-term clinical outcomes and harms are needed.
Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, AB, Canada.
Jennifer C
JC
Seida
Diana R
DR
Mager
Lisa
L
Hartling
Ben
B
Vandermeer
Justine M
JM
Turner
D004041:Dietary Fats / Q000627:therapeutic use*; D005217:Fat Emulsions, Intravenous / Q000737:chemistry / Q000627:therapeutic use*; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use*; D006331:Heart Diseases / Q000628:therapy; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000628:therapy*; D008107:Liver Diseases / Q000628:therapy; D010288:Parenteral Nutrition
D004041:Dietary Fats; D005217:Fat Emulsions, Intravenous; D015525:Fatty Acids, Omega-3