title: Plasma fatty acids in premature infants with hyperbilirubinemia: before-and-after nutrition support with fish oil emulsion.
abstract: Infants who are dependent on parenteral nutrition (PN) sometimes develop PN-associated cholestasis (PNAC). A compassionate use protocol, approved by the U.S. Food and Drug Administration and the institutional review board, guided enrollment of hospitalized infants with PNAC (<1 year of age, PN dependence for >3 weeks). Plasma concentrations of essential fatty acids were monitored before and after a soybean-based PN lipid, infused at 3 g/kg body weight/d, was replaced by an experimental fish oil-based intravenous fat emulsion (FO-IVFE) at 1.0 g/kg/d. All participants were born premature (n = 10; 20% male). At enrollment, infants were (mean ± SD) 86.5 ± 53.5 days of life and weighed 2.24 ± 0.87 kg; direct bilirubin was 5.5 ± 1.3 mg/dL. After treatment, blood concentrations significantly increased from baseline (P < .017) for circulating eicosapentaenoic acid (6.3 ± 3.0 to 147.8 ± 53.1 µg/mL), docosahexaenoic acid (20.7 ± 6.5 to 163.7 ± 43.4 µg/mL), pristanic acid (0.01 ± 0.01 to 0.17 ± 0.03 µg/mL), and phytanic acid (0.06 ± 0.03 to 0.64 ± 0.15 µg/mL). In contrast, total plasma ω-6 fatty acids (including linoleic acid) decreased (P < .017). The triene/tetraene ratio remained below the threshold value of 0.2 that defines ω-6 deficiency. No adverse effects were observed attributable to FO-IVFE. Discontinuation of FO-IVFE was typically due to infants (body weight 3.76 ± 1.68 kg) transitioning to enteral feeding rather than for resolution of hyperbilirubinemia (direct bilirubin 7.9 ± 4.8 mg/dL). These exploratory results suggest that FO-IVFE raises circulating ω-3 fatty acids in premature infants without development of ω-6 deficiency in the 8.3 ± 5.8-week time frame of this study.
authors: Childrens National Medical Center, Washington, DC 20010, USA. CKlein@cnmc.org
authors: Catherine J
authors: CJ
authors: Klein
authors: Thomas G
authors: TG
authors: Havranek
authors: Mary E
authors: ME
authors: Revenis
authors: Zahra
authors: Z
authors: Hassanali
authors: Louis M
authors: LM
authors: Scavo
mesh_terms: D001663:Bilirubin / Q000097:blood; D002779:Cholestasis / Q000097:blood / Q000188:drug therapy; D057176:Compassionate Use Trials; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage*; D005227:Fatty Acids / Q000097:blood; D005228:Fatty Acids, Essential / Q000097:blood; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage* / Q000097:blood; D043371:Fatty Acids, Omega-6 / Q000008:administration & dosage* / Q000097:blood; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage*; D006801:Humans; D006932:Hyperbilirubinemia / Q000097:blood* / Q000188:drug therapy; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood*; D007235:Infant, Premature, Diseases / Q000097:blood / Q000188:drug therapy; D007363:Intensive Care Units, Neonatal; D008297:Male; D015596:Nutrition Assessment; D010289:Parenteral Nutrition, Total / Q000379:methods; D011446:Prospective Studies; D014280:Triglycerides / Q000097:blood
chemical_list: D005217:Fat Emulsions, Intravenous; D005227:Fatty Acids; D005228:Fatty Acids, Essential; D015525:Fatty Acids, Omega-3; D043371:Fatty Acids, Omega-6; D005395:Fish Oils; D014280:Triglycerides; C002844:pristanic acid; D001663:Bilirubin