title: Pediatric intestinal failure-associated liver disease is reversed with 6 months of intravenous fish oil.
abstract: BACKGROUND
  Studies have suggested that when intravenous (IV) soybean oil (SO) is replaced with fish oil (FO), direct hyperbilirubinemia is more likely to resolve. The necessary duration of FO has not been established. This study seeks to determine if 24 weeks of FO is an effective and safe therapy for intestinal failure-associated liver disease (IFALD).
  
  
  METHODS
  This is a clinical trial using patients with IFALD between the ages of 2 weeks and 18 years. SO was replaced with FO (1 g/kg/d) in 10 patients who were receiving most of their calories from parenteral nutrition (PN). Patients were compared with 20 historic controls receiving SO. SO for both groups was prescribed by the primary medical team at variable doses. The primary outcome was time to reversal of cholestasis. Secondary outcomes were death, transplant, and full enteral feeds. Safety measurements included growth, essential fatty acid deficiency, and laboratory markers to assess bleeding risk.
  
  
  RESULTS
  The Kaplan-Meier method estimated that 75% in the FO group would experience resolution of cholestasis by 17 weeks vs 6% in the SO group (P < .0001). When compared with the SO group, the FO group had decreased serum direct bilirubin concentrations at weeks 8 (P = .03) and 12, 16, 20, and 24 weeks (P < .0001). Although length z score at the end of the study increased in the FO group compared with baseline (P = .03), there were no significant differences in other outcomes.
  
  
  CONCLUSIONS
  A limited duration of FO appears to be safe and effective in reversing IFALD.
authors.affiliation: Department of Pediatrics, Division of Neonatology and Developmental Biology, Neonatal Research Center KCalkins@mednet.ucla.edu.
authors.forename: Kara L
authors.initials: KL
authors.lastname: Calkins
authors.affiliation: Department of Surgery, Division of Pediatric Surgery.
authors.forename: James C Y
authors.initials: JC
authors.lastname: Dunn
authors.affiliation: Department of Surgery, Division of Pediatric Surgery.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Shew
authors.affiliation: Department of Nursing.
authors.forename: Laurie
authors.initials: L
authors.lastname: Reyen
authors.affiliation: Department of Surgery.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Farmer
authors.affiliation: Department of Pediatrics, Division of Neonatology and Developmental Biology, Neonatal Research Center.
authors.forename: Sherin U
authors.initials: SU
authors.lastname: Devaskar
authors.affiliation: Department of Surgery Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, David Geffen School of Medicine, Mattel Children's Hospital UCLA, University of California, Los Angeles.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Venick
mesh_terms: D061605:Administration, Intravenous; D001663:Bilirubin / Q000097:blood; D002779:Cholestasis / Q000097:blood / Q000188:drug therapy; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000150:complications / Q000188:drug therapy*; D008107:Liver Diseases / Q000150:complications / Q000188:drug therapy*; D008111:Liver Function Tests; D008297:Male; D010288:Parenteral Nutrition; D011446:Prospective Studies; D013024:Soybean Oil / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005217:Fat Emulsions, Intravenous; D005395:Fish Oils; D013024:Soybean Oil; D001663:Bilirubin
keywords: cholestasis; fish oil; prematurity; short bowel syndrome; soybean oil
references.citation: J Pediatr Gastroenterol Nutr. 2013 Apr;56(4):364-9
references.pmid: 23201707
references.citation: Arch Dis Child. 2012 Mar;97(3):211-4
references.pmid: 22247247
references.citation: J Pediatr Surg. 2013 Jan;48(1):228-32
references.pmid: 23331820
references.citation: Pediatr Res. 2009 Dec;66(6):698-703
references.pmid: 19687773
references.citation: J Pediatr. 1997 Nov;131(5):700-6
references.pmid: 9403649
references.citation: J Pediatr Surg. 1993 Oct;28(10):1270-4; discussion 1274-5
references.pmid: 8263685
references.citation: JPEN J Parenter Enteral Nutr. 2013 Jul;37(4):448-9
references.pmid: 23533223
references.citation: Crit Rev Food Sci Nutr. 2005;45(3):205-29
references.pmid: 16048149
references.citation: Surg Gynecol Obstet. 1982 May;154(5):641-7
references.pmid: 7071699
references.citation: J Pediatr Gastroenterol Nutr. 2003 Aug;37(2):161-7
references.pmid: 12883303
references.citation: J Pediatr Surg. 2011 Oct;46(10):1913-7
references.pmid: 22008327
references.citation: Eur J Pediatr. 2008 Feb;167(2):197-202
references.pmid: 17436017
references.citation: J Pediatr Surg. 2011 Jan;46(1):122-7
references.pmid: 21238652
references.citation: Pediatrics. 2009 May;123(5):1337-43
references.pmid: 19403500
references.citation: JPEN J Parenter Enteral Nutr. 2000 Nov-Dec;24(6):345-50
references.pmid: 11071594
references.citation: J Pediatr Gastroenterol Nutr. 2010 Oct;51(4):514-21
references.pmid: 20531018
references.citation: Gastroenterology. 1993 Dec;105(6):1806-13
references.pmid: 8253356
references.citation: J Pediatr Gastroenterol Nutr. 2012 Jun;54(6):803-11
references.pmid: 22197940
references.citation: J Pediatr. 2012 Mar;160(3):421-7
references.pmid: 21982303
references.citation: JPEN J Parenter Enteral Nutr. 2010 Sep-Oct;34(5):485-95
references.pmid: 20852176
references.citation: JPEN J Parenter Enteral Nutr. 2009 Sep-Oct;33(5):541-7
references.pmid: 19571170
references.citation: Transplantation. 2008 May 27;85(10):1378-84
references.pmid: 18497673
references.citation: J Pediatr. 2010 Feb;156(2):327-31
references.pmid: 20105644
references.citation: J Pediatr. 2012 Oct;161(4):723-8.e2
references.pmid: 22578586
references.citation: J Perinatol. 2011 Jul;31(7):471-6
references.pmid: 21233795
references.citation: J Ky Med Assoc. 2009 Feb;107(2):55-7
references.pmid: 19263944
references.citation: Eur J Clin Nutr. 2010 Sep;64(9):940-7
references.pmid: 20551967
references.citation: J Pediatr Surg. 2005 May;40(5):755-62
references.pmid: 15937809
references.citation: JPEN J Parenter Enteral Nutr. 2013 Jul;37(4):498-505
references.pmid: 22767698
references.citation: Am J Clin Nutr. 2011 Sep;94(3):749-58
references.pmid: 21775562
references.citation: J Pediatr. 2013 Jan;162(1):56-61
references.pmid: 22878111
references.citation: Pediatr Res. 1999 Feb;45(2):202-8
references.pmid: 10022591
references.citation: J Pediatr Surg. 2011 Apr;46(4):666-673
references.pmid: 21496535
references.citation: Transplantation. 2008 May 27;85(10):1385-6
references.pmid: 18497674
references.citation: Pediatrics. 2006 Apr;117(4):1253-61
references.pmid: 16585322
references.citation: Ann Surg. 2009 Sep;250(3):395-402
references.pmid: 19661785
references.citation: J Pediatr Gastroenterol Nutr. 2012 Jun;54(6):797-802
references.pmid: 22157927
references.citation: Curr Opin Clin Nutr Metab Care. 2010 May;13(3):321-6
references.pmid: 20393276
references.citation: J Pediatr Surg. 2010 Jan;45(1):95-9; discussion 99
references.pmid: 20105587
references.citation: Pediatrics. 2008 Mar;121(3):e678-86
references.pmid: 18310188
references.citation: Pediatrics. 2008 Sep;122(3):e573-82
references.pmid: 18762491
references.citation: J Pediatr Gastroenterol Nutr. 2007 Feb;44(2):237-44
references.pmid: 17255838
references.citation: Transplant Proc. 2006 Jul-Aug;38(6):1692-3
references.pmid: 16908250
references.citation: Am J Physiol Gastrointest Liver Physiol. 2007 Dec;293(6):G1134-46
references.pmid: 17916651
references.citation: Nutr Clin Pract. 2007 Dec;22(6):664-72
references.pmid: 18042955
references.citation: J Surg Res. 2011 Sep;170(1):27-31
references.pmid: 21601876
references.citation: Pediatr Res. 2007 Sep;62(3):301-6
references.pmid: 17622954
references.citation: J Pediatr Surg. 2011 Jul;46(7):1361-7
references.pmid: 21763835
references.citation: JPEN J Parenter Enteral Nutr. 2012 Sep;36(5):587-95
references.pmid: 22275330
references.citation: Eur J Pediatr Surg. 2010 Mar;20(2):139-42
references.pmid: 20178080
references.citation: J Pediatr Gastroenterol Nutr. 2009 Feb;48(2):209-15
references.pmid: 19179884
references.citation: J Perinatol. 2007 May;27(5):284-90
references.pmid: 17344923
references.citation: J Pediatr. 2008 Jan;152(1):59-62
references.pmid: 18154901
references.citation: J Pediatr Surg. 2011 Dec;46(12):2376-82
references.pmid: 22152886
references.citation: J Pediatr. 2013 Apr;162(4):793-798.e1
references.pmid: 23164314
references.citation: J Pediatr Gastroenterol Nutr. 1998 Aug;27(2):131-7
references.pmid: 9702641
references.citation: Eur J Pediatr Surg. 2009 Dec;19(6):348-53
references.pmid: 19866409
references.citation: Arch Pediatr Adolesc Med. 2000 Jul;154(7):725-31
references.pmid: 10891026
references.citation: JPEN J Parenter Enteral Nutr. 2010 Jan-Feb;34(1):32-7
references.pmid: 19587385