title: Risk of post-procedural bleeding in children on intravenous fish oil.
abstract: BACKGROUND
  Intestinal failure-associated liver disease (IFALD) can be treated with parenteral fish oil (FO) monotherapy, but practitioners have raised concerns about a potential bleeding risk. This study aims to describe the incidence of clinically significant post-procedural bleeding (CSPPB) in children receiving FO monotherapy.
  
  
  METHODS
  A retrospective chart review was performed on patients at our institution treated with intravenous FO for IFALD. CSPPB was defined as bleeding leading to re-operation, transfer to the intensive care unit, re-admission, or death, up to one month after any invasive procedure.
  
  
  RESULTS
  From 244 patients reviewed, 183 underwent ≥1 invasive procedure(s) (n = 732). Five (0.68%, 95% CI 0.22-1.59%) procedures resulted in CSPPB. FO therapy was never interrupted. No deaths due to bleeding occurred.
  
  
  CONCLUSIONS
  Findings suggest that FO therapy is safe, with a CSPPB risk no greater than that reported in the general population. O3FA should not be held in preparation for procedures or in the event of bleeding.
authors.affiliation: Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Prathima
authors.initials: P
authors.lastname: Nandivada
authors.affiliation: Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Anez-Bustillos
authors.affiliation: Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Alison A
authors.initials: AA
authors.lastname: O'Loughlin
authors.affiliation: Clinical Research Center, Biostatistics Core, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Mitchell
authors.affiliation: Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Baker
authors.affiliation: Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Duy T
authors.initials: DT
authors.lastname: Dao
authors.affiliation: Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Gillian L
authors.initials: GL
authors.lastname: Fell
authors.affiliation: Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Alexis K
authors.initials: AK
authors.lastname: Potemkin
authors.affiliation: Department of Pharmacy, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Gura
authors.affiliation: Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA.
authors.forename: Ellis J
authors.initials: EJ
authors.lastname: Neufeld
authors.affiliation: Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, MA, USA. Electronic address: mark.puder@childrens.harvard.edu.
authors.forename: Mark
authors.initials: M
authors.lastname: Puder
mesh_terms: D005217:Fat Emulsions, Intravenous; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage* / Q000009:adverse effects*; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007262:Infusions, Intravenous / Q000009:adverse effects; D007410:Intestinal Diseases / Q000188:drug therapy*; D017093:Liver Failure / Q000188:drug therapy*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D005217:Fat Emulsions, Intravenous; D005395:Fish Oils
keywords: Fish oil; Intestinal failure-associated liver disease; Omega-3 fatty acids; Post-procedure bleeding