title: Parenteral fish oil-containing lipid emulsions may reverse parenteral nutrition-associated cholestasis in neonates: a systematic review and meta-analysis.
abstract: BACKGROUND
  Growing evidence indicates that fish oil-containing lipid emulsions have a beneficial effect on parenteral nutrition-associated cholestasis (PNAC) in adults; however, data are limited in neonates regarding the effect of fish oil on PNAC.
  
  
  OBJECTIVE
  We conducted a meta-analysis of studies that addressed the effect of fish oil-containing lipid emulsions on reversing and preventing PNAC.
  
  
  METHODS
  We searched PubMed, the EMBASE database, and the Cochrane Library for this systematic review and meta-analysis. The methodologic assessment of studies was performed with the Jadad scale and the Newcastle-Ottawa Scale. Comprehensive Met-Analysis version 2.0 was used for the statistical analysis. We performed a meta-analysis with the primary outcomes of reversal of PNAC and the occurrence of PNAC in newborn infants, including preterm infants, after parenteral administration of fish oil-containing lipid emulsions.
  
  
  RESULTS
  Of the 36 studies identified, 7 fulfilled the inclusion criteria and were used in this meta-analysis, including 3 studies with 93 participants in which reversal of PNAC was an outcome and 4 studies with 1012 participants on preventing PNAC. The use of fish oil-containing lipid emulsions was more likely to reverse PNAC (OR: 6.14; 95% CI: 2.27, 16.6; P < 0.01), but the use of fish oil-containing lipid emulsions did not have a significant effect on the development of PNAC (OR: 0.56; 95% CI: 0.28, 1.10; P = 0.09) compared with soybean-based or olive oil-based lipid emulsions.
  
  
  CONCLUSIONS
  The pooled data suggest that the use of fish oil-containing lipid emulsions is effective for reversing PNAC but cannot prevent PNAC in neonates who require prolonged parenteral nutritional support.
authors: Department of Pediatrics, Konkuk University Medical Center.
authors: Hye Won
authors: HW
authors: Park
authors: Department of Pediatrics, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea; and.
authors: Na Mi
authors: NM
authors: Lee
authors: Department of Pediatrics, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
authors: Ji Hee
authors: JH
authors: Kim
authors: Department of Pediatrics, Konkuk University Medical Center.
authors: Kyo Sun
authors: KS
authors: Kim
authors: Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea; snkim@kuh.ac.kr.
authors: Soo-Nyung
authors: SN
authors: Kim
mesh_terms: D002779:Cholestasis / Q000628:therapy*; D004655:Emulsions / Q000737:chemistry; D005395:Fish Oils / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development; D000069463:Olive Oil; D010288:Parenteral Nutrition; D057947:Parenteral Nutrition Solutions / Q000737:chemistry*; D010938:Plant Oils / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D013025:Glycine max / Q000737:chemistry; D016896:Treatment Outcome
chemical_list: D004655:Emulsions; D005395:Fish Oils; D000069463:Olive Oil; D057947:Parenteral Nutrition Solutions; D010938:Plant Oils
keywords: Neonate; Omegaven; SMOFlipid; fish oil; parenteral nutrition–associated cholestasis