title: Intravenous lipid emulsions in pediatric patients with intestinal failure.
abstract: The incidence of cholestatic liver disease (CLD) in pediatric patients suffering intestinal failure (IF) is not well established. Due to persistent portal inflammation, about 20% of these patients will progress to end-stage intestinal failure associated liver disease (IFALD) leading to liver transplant or death.
  
  
  OBJECTIVE
  Premature babies as well as infants with short bowel syndrome (SBS) and repeated sepsis (catheter or small intestinal bacterial overgrowth related) are at risk of developing CLD. Clinical data in SBS infants focused on intravenous lipid emulsion (ILE) as an important factor of CLD.
  
  
  RESULTS
  Compared to the last generation of composite ILE containing fish oil (FO), soybean oil (SO) based ILE, have marked differences in term of oil source, omega-3 fatty acids (FAs) composition, vitamin E (α-tocopherols) and plant sterols contents, that may explain CLD and CLD reversal. Randomized controlled trials and meta-analysis allow the following recommendations.
  
  
  CONCLUSIONS
  In pediatric patients with developing or established CLD or IFALD, potential causes should be explored and pure SO ILE should be avoided. A reduction of the ILE dosage and/or the use of the new composite FO based ILE, may be recommended along with the treatment and management of other risk factors. The 10% pure FO ILE should not be used as a sole provision of IV lipids in paediatric patients on total PN but can only serve as a short-term rescue treatment.
authors.affiliation: Department of Pediatric Gastroenterology, Hepatology and Nutrition, Intestinal Failure Rehabilitation Center, National Reference Centre for Rare Digestive Diseases, APHP Necker-Enfants Malades Hospital, Paris-Descartes University, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Goulet
authors.forename: Cécile
authors.initials: C
authors.lastname: Lambe
mesh_terms: D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D005260:Female; D005395:Fish Oils / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007410:Intestinal Diseases / Q000628:therapy*; D008297:Male; D010288:Parenteral Nutrition / Q000379:methods*; D013024:Soybean Oil / Q000627:therapeutic use*
chemical_list: D005217:Fat Emulsions, Intravenous; D005395:Fish Oils; D013024:Soybean Oil