title: Higher Doses of Fish Oil-Based Lipid Emulsions Used to Treat Inadequate Weight Gain and Rising Triene:Tetraene Ratio in a Severely Malnourished Infant With Intestinal Failure-Associated Liver Disease.
abstract: Fish oil-based lipid emulsions (FOLEs) have been used to treat cholestasis in children with intestinal failure-associated liver disease (IFALD). When FOLEs are dosed at 1 g/kg/d, essential fatty acid (EFA) deficiency typically does not occur. We describe the clinical course of a severely malnourished parenteral nutrition-dependent infant with IFALD. Baseline EFA panels were normal upon starting FOLE at 1 g/kg/d. Despite biochemical improvement in IFALD, weight velocity was below target and biochemical EFA status worsened, even after correction for other factors affecting weight. The FOLE dose was increased to 1.5 g/kg/d, resulting in improvement of weight velocity and EFA status. This suggests that in severely malnourished infants being treated for IFALD, higher doses of FOLE may be required for adequate growth and to prevent EFA deficiency.
authors.affiliation: 1 Department of Pharmacy, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Riedy
authors.affiliation: 2 Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Brittany
authors.initials: B
authors.lastname: DePaula
authors.affiliation: 3 Vascular Biology Program and Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Puder
authors.affiliation: 1 Department of Pharmacy, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Gura
authors.affiliation: 2 Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Sztam
mesh_terms: D002779:Cholestasis / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage* / Q000737:chemistry; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000150:complications / Q000628:therapy*; D008107:Liver Diseases / Q000150:complications / Q000628:therapy*; D044342:Malnutrition / Q000628:therapy*; D010288:Parenteral Nutrition; D015430:Weight Gain / Q000187:drug effects*
chemical_list: D005217:Fat Emulsions, Intravenous; D005395:Fish Oils
keywords: essential fatty acid deficiency; fat emulsion; malnourish; omega-3 fatty acid; parenteral nutrition; refeeding